Monday, July 25, 2011

Electronic Medical Records Shortfall

July 25, 2011- For five years, in countless blogs, and in two books – Obama, Doctors, and Health Reform (2009) and Health Reform Maze (2011, now at printers), I’ve been saying digital medical records are a dud.

This does not mean I’m a technology Luddite, or a conservative who resists Obamacare in all of its manifestations. It means I’m a realist. For multiple reasons, EHRs simply don’t work for hospitals or doctors. For most physicians, in their present form, EHRs are impractical, unworkable, disruptive, and overly expensive without any tangible return on investment.

EHRs might work if government totally subsidized them without unrealistic “meaningful,” i.e., bureaucratic, conditions, or if EHR vendors offered them for “free” with advertisers footing the bill. But only then would they work if EHRs were useful and user-friendly.

One problem, as I see it, is theological. EHR enthusiasts see digital data in quasi-religious terms, as some sort of government electronic magic wand or Holy Grail that will transform health care into a more perfect, more tractable, more traceable system.

It ain’t going to happen. I’m reminded of a country song I used to hear as a youth in Tennessee, “Mother’s not dead. She’s only sleeping, patiently waiting for Jesus to come.” It’s going to be a long wait, as Sally Pipes explains below.

Government Mandates Make Health Savings More Elusive

By Sally C. Pipes,, July 18, 2011

The Centers for Medicare and Medicaid Services recently released some data that show that the digital revolution continues to evade health care.

Through mid-May, just 1,026 registered hospitals and physicians out of a possible 56,599 have demonstrated that they are using electronic medical records and other health information technology in accordance with federal standards. That’s a scant 2%.

The federal government has tried to promote the switch from paper medical records to electronic ones in hopes of improving efficiency and bringing down health costs.

It’s even putting money behind the push — some $27 billion over 10 years, or from $44,000 to $63,750 per physician and up to $2 million per hospital.

But even that vast sum of taxpayer lucre cannot will the necessary innovations into being.

Worse, like so many roads paved with good intentions, this one may yield some unfortunate consequences — paramount among them a decline in the number of doctors who will take Medicare patients.

A Rand Corporation study in 2005 concluded that health IT could save our health care system about $77 billion a year. Other studies have put annual savings in the $80 billion to $100 billion range.

The Rand study is popular with cost-cutters, but read the fine print: “much of the gains can only be achieved if all, or nearly all, of the healthcare organizations participate.”

At this stage, the cost of implementing health IT is a high threshold for many providers to cross. The average initial cost of an electronic health records (EHR) system is $44,000 per physician, with ongoing maintenance estimated at $8,500 a year.

Most physician office visits still occur in practices with 10 or fewer doctors. These aren’t just medicine men; they’re also small businesses, with the same concerns about remaining profitable as others. These health IT mandates only add a new level of complexity.

According to the head of the Business Management Department at North Carolina State University’s College of Management, “the main barriers to the adoption of EHR by small healthcare firms are due to legal and economic uncertainty.”

For years, politicians in Washington have been seeking a way to harness the savings from health IT. Each time they have tried, they ended up putting success further off.

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), predicting that portable health records would usher in a new golden age. Fifteen years later, we’re still waiting.

In 2004, President Bush signed Executive Order 13335 setting the goal of a nationwide health information network within ten years. Time is almost up, and government data show that only 1,026 registered hospitals and physicians — out of 56,599 — use technology that meets federal standards.

Washington politicians have spent years fiddling with carrots and sticks and regulations and mandates. In the process, they have gummed up the work that could have been done by the free market and private innovators.

If we want results, Washington needs to stop trying to legislate Star Trek-style medical tricorders into being. We’re better off leaving technology to the real-world innovators who have put communicators (er, rather, cell phones) into the hands of just about everyone.

Sally C. Pipes is President, CEO and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Truth About Obamacare (Regnery).


ALaferriere said...

Philosophically, the idea of digital health records does make sense in light of the current technology available to us. The real problem, however, is security. A decade ago, HIPPA told healthcare firms and medical practices that they could not track patients using their Social Security number but many still ask for the number. President Obama’s HITECH Act (2009) addressed what HIPPA did not but omitted the discussion surrounding security. The questions we should be asking are, “How do we authenticate (positively identify) the parties?” and, “How do we encrypt (read obfuscate) the data?” (Vamosi, 2011)

Nearly all devices linked to the internet have what is called an IP number that gives them a unique online identity and that includes many implantable medical devices (as an aid to online monitoring). All a motivated computer hacker needs is that IP number and with a little time, the security of that device is compromised. It does not take much imagination to see the problems that poor security can create. Moreover, if this seems implausible, it would not take an MBA to understand why physicians and small practices would use of-the-shelf wireless tablet and laptop computers during a patient visit – it is readily available and relatively inexpensive. This is a security breach waiting to happen unless there is a robust security system in place.

The EHR discussion should include security as an equal partner with pragmatism and politics. I strongly recommend Robert Vamosi’s book, “When Gadgets Betray Us.” He does an excellent job of exposing the dark side of our new technology.

Richard L. Reece, MD said...

Thank you, ALaferriere, for your comments. I agree security is a huge issue, particularly in wake of Wikileaks and the News Corporation hacking scandals. Many observers had said privacy is obselete. This is not true for health care, which remains for most a very personal and private affair. said...

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