Thursday, January 28, 2010

Electronic Medical Records: Universal Electronic Health Records - The Right Thing to Do?

The January 21 New England Journal of Medicine contains an article entitled “Accelerating the Use of Electronic Health Records in Physician Practices.” Two physicians from the Columbia University Medical Center wrote it. The article says the North Shore Hospital System on Long Island has announced it will pay an incentive of up to $40,000 for each physician in its network to adopt its EHR – paying 50% of the cost to physicians who install an EHR that communicates with the hospital and up to 85% of the cost if the physician also shares de-identified data on the quality of care.

The article contains a figure showing this data.

Physicians who have not adopted EHRs by size of group.

• 1-3 doctors, 92%
• 4-5 doctors, 88%
• 6-10 doctors, 78%
• 11-50 doctors, 71%
• 50 doctors or more, 49%

EHRs Not Popular Among Doctors Who Deliver Most Care

All told, 85% of doctors in practices of 10 or less have not adopted EHRs. It is important to note these doctors supply 85% to 90% of American health care.

These numbers caused the authors to observe,” The decision by North Shore to provide a financial incentive as well as the software license suggests that many physicians still do not believe that current –generation EHRs will offer a return on investment directly to physicians.”

In the minds of the government and information technology establishment, EHRs are the only way to go, the key to physician efficiency and effectiveness and to better care.

Their minds are made up. Yet after nearly 10 years of EHR promotion, physicians remain profoundly skeptical about their use and are installing EHRs in limited numbers. Less than 15% have installed EHRs despite all the hype and promise of incentives.

Politically-Incorrect Questions

In any event, the NEJM numbers caused me to ask a series of politically incorrect questions: Is it possible that the physicians are right – that EHRs are not the right thing to do? Is it possible EHRs will not offer a return on investment, will not improve care, will not lower costs, will invade patient privacy, will disrupt practice efficiencies, and will be used to second-guess physicians?

Is it possible, in short, that EHRs are not what they are cracked up to be?

Drucker Aphorisms

The late Peter F. Drucker, 1909-2005, was famous for making pithy observations like these: "Efficiency is doing things right, effectiveness is doing the right thing." "Doing the right thing is more important than doing things right." "Management is doing things right, leadership is doing the right thing?"

Are EHRs, widely acclaimed as being the key to practice efficiency, really effective? EHRs may be “doing things right” among the political and wonk gentry, but are EHRs “the right thing to do” for practicing physicians? Are they more trouble than they are worth? Is it possible EHRS are not worth the $20 billion proposed to be spent on EHRs? Is it possible the herculean effort to implement universal,inteoperable EHR adoption between hospitals and doctors will be a failed boondoggle of the first order and a monumental waste of taxpayer money? Is it possible EHRs will drive up costs with no quality gain?

Just Asking

I am just asking. Somebody has to ask the tough questions.

Before you answer, keep in mind we are nearly a decade into this effort, and physicians who deliver care are still profoundly skeptical of EHRs in terms of efficiency and effectiveness. Could they be right?


HaynesBE said...

I have been enjoying several of your recent posts.

In regards to this particular question, when is using government force to implement a program like this EVER doing the "right thing"? Doesn't the means (coercion) negate whatever good might be achieved?

In other words, somethings, because of means employed, can never be the "right thing".

Richard L. Reece, MD said...

There are limits to government bulldozing and to imposing forced technologies on hospitals and doctors. I'm reminded our our failure in Vietnam to root out the guerillas with napalm and airpower. One critic observed, "You can't weed a garden with a bulldozer." Federal intervention into private affairs has limits.