Ezra Klein thinks he knows medicine . . . but doesn’t

Ezra Klein naively wonders why all doctors don’t have electronic health records:

To this day, I’ve never read a compelling explanation of why the nation’s doctors and hospitals haven’t broadly adopted electronic medical records.

Please educate him. (via Arnold Kling)

Comments

Rich, MD
Elliott,
I am not one of thse you listed, but I am a doc who reads this blog and I take exception to your comment.
I am a physician in a private practice. I have one partner. I make almost every decision regarding business in my office. I am not a technophobe, and I have one of the most technologically advanced private practices in the not-so-immediate area (having been featured in a regional newspaper, giving lectures, and as a consultant on the matter, as well). I also run a small EMR software company, so I see this from both sides, so-to-speak.
As a business man, most of the comments on Ezra’s site hit home. It is a business decision based on need, costs, and potential improvement (or decline) in reimbursement.
To dismiss a group of pressionals wholesale based on whatever chip you have on your shoulder is ridiculous and, for someone who posts so much here and elsewhere, irresponsible.
You are free, of course, to write what you want. But if you believe that Kevin’s readers are lying, greedy, delusional, and self-important, and that Kevin’s bias renders his posts “defecation,” I have to wonder why you return so often.
Respectfully,
Rich
Kevin
Over the line Elliott.
You can say the same thing without the censored expletives.
Kevin
Elliott
Kevin’s post amounted to a “sic ‘em”. I think that crossed a line and was happy to respond in kind with an expletive laden F*** Y**! He suggested that Ezra Klein is naive when, in fact, he is one of the best commentators on healthcare in the blogosphere. Go over and read the comments to that post. Most of them are thoughtful and illuminating in stark contrast to the anonymous blather that passes for commentary at this blog.
I read this blog because originally I found Kevin to be interesting. At times I disagreed with him, but I thought that he was reasonable. More and more, he has shown himself to be less than reasonable. The first time I can specifically recall is that he has claimed that the Texas physician population has grown as a result of malpractice reform when no such conclusion is warranted by the actual numbers recorded by the Texas govenrnment. I saw it further when he quotes right-wing distorters like the Fraser Institute or Catron or the WSJ editorial page to support his position when all they are doing is making bald assertions. Those assertions are many time scontradicted directly by the facts or, even if the facts are true, they don’t stand up to scrutiny when put in a broader context. When such is the case, he ignores the rebuttal.
Finally, his character assasssination of Dr. Nissen and John Edwards are Drudge/Limbaugh like in their execution. I come here because 1) I am interested in what a fairly mainstream physician feels about these issues even if I found those opinions profoundly ill-informed or biased. and 2) I’m somewhat interested in pricking his bubble. Since he doesn’t seem to be open to reasonable argument, I intentionally insult him. and 3) His blog is not totally unredeemable. Often times when he talks about actual medical issues or the role of the physician, he or the places he points are interesting.
Rich, you have consistently been a civil commentator and, I hope, I have always responded in kind to your comments, but Kevin and his anonymous minions are not in the same league as you so I respond differently.
Rich, MD
I respect your opinion, even if I disagree with it.
I would only point out that, just as you characterize Catron and others as “right-wing distorters” there are reasonable people who would similarly (or dichotomously) characterize Mr. Klein and others with whom you might agree.
Mr. Klein has made some false assertions as well, but you seem to respect his opinions. Should I dismiss him because of those false assertions, as easily as you dismiss Catron, WSJ, and so forth?
Example in this context: “ViSTA is free” – yes, but support and maintainance, hardware, and implementation are not – but you would not know that from Mr. Klein’s column.
He gives the impression that there are a plethora of incentives for physicians to implement EMR/EHR, concluding that “It’s not as if it wouldn’t be cheaper and easier for them.”
Well, yes, maybe eventually. As a software vendor, I can tell you that it is not cheap or easy to implement even ViSTA. The devil is in the details, but they are largely ignored by Mr. Klein, who also seems to forget that, unlike the local mechanic or donut shop, the cost of implementation cannot easily be passed on to the customers via increases in pricing.
Furthermore, evidence that impementing EMR results in increased reimbursement is lacking, though in my experience, with the right software and Advice from professionals who know what they are doing, significant cost savings CAN be effected. These cost savings tend to much less, however, than the initial implementation costs.
Elliott
I saw the Vista is free comment and cringed because the licensing fee in my opinion was ridiculous. The licensing fee then hampered the number of companies who would be willing to support and install because the market all of a sudden was limited. It was based, from what I saw, on the howling of certain large IT companies who feared competition.
I think that Ezra was talking from a policy point-of-view and not from a operational point-of-view. I interpreted his post as to asking since integrate healthcare IT is better (more efficient) than our current mess, why doesn’t someone figure out how to implement it?
Arnold Kling’s answer (someone who I rarely agree with and am neutral as to my respect for him – he argues that the New Deal hurt people economically) is the best thing I have ever seen him write. Kevin would have been best served by quoting liberally from Mr. Kling’s response rather than siccing his commentors on Klein.
Anonymous
zzzzzzzzzzz
Anonymous
One of the reasons there has been more use of EMR’s in Europe is data-mining.
Google “NHS” and “The Spine” for example.
I’ll leave it up to you to decide if you like your personal information so available to the government.
The NHS has had a big embarrassment with physician personal information made available (through their equivalent of the Match, a lot of very personal info was available until they got caught). If the UK can’t protect physician privacy, what chance does the patient have?
Catron
At risk of being dismissed as a “right-wing distorter,” I’d like to point out that new technologies are adopted en masse for one reason: because they are cheaper, faster, and more user-friendly than the old technologies they replace. EMR simply isn’t there yet.
We keep hearing about EMR from Klein, Holt, et al primarily because it’s easier to promote some magic bullet than to work through the infinitely complex problems that bedevil the system and come up with real solutions.
Anonymous
Well, who is going to do the difficult work? So far, few physicians have been willing to do much more than bitch incessantly. None are willing to give up the golden goose, no matter how much they despise it, it seems.
And yet the physicians are the ones most affected by the proposed solutions.
Anonymous
Despise what? That’s the entire point. Most physicians DON’T have a problem with paper records. They are, generally speaking, much less of a pain in the ass. It’s everyone BUT them who wants it, because they will reap the benefits without having to click through 20 screens asking if you REALLY want to order a gram of Ancef or do nothing for an hour because the system crashed.
Anonymous
Doctors are definitely NOT technophobes, if they were, all the gallbladders would be comming out the old fashioned way.
Doctors have a strong interest in maximizing productivity as that is money in thier pocket.
Doctors have a strong interest in maximizing quality and use computers in their practices everyday in order to do that. They have been at the forefront of developing computer applications for their profession. That is what the “C” in CAT scan stands for.
Most doctors don’t use EMR because for most doctors they do not enhance productivity, quality, or profit. It is that simple.
I am a non-technophobe physician who has built computers, other electronic devices, and programed in 3 languages. I currently work full-time for an IT company (not writing code) and carry a part-time private practice. I have used an EMR in the past in a big clinic and found it to have advantages and disadvantages in that setting but my own well-honed paper system was always more efficient on a day-to-day basis.
In the private practice I managed to write a personalized system that for me is as efficient as paper. I do not use it. It is as efficient but not more efficient and in the small practice setting offers virtually no advantages. It still presents several disadvantages. The determinative ones for me are upgrade costs and privacy.
I pulled a paper record from 1990 recently. It took 40 seconds to find the file box and pull the file. There it was, readable in plain English with nothing done to it for the last 17 years. If I had digitized it, it would be in an unreadable format both physically and digitally, unless I had either kept my legacy systems or had upgraded everything every few years to new formats–a continuous input of time and money.
If I don’t back up off site, I lose one of the main advantages of digital. If I do, then I put the data at risk. My patients privacy is very very important to them and I don’t like the idea of someone being able to steal 10,000 records from NIgeria or Bangalore with a push of a button. If someone steals my paper, he has to at least be here to do it, physically break in, and risk a hernia to steal that many. Massive data breaches occur every single day. HIPAA is more of a problem than a protection. Pharmacy data is sold routinely.
A lot of these people pushing Health IT are going to be very anxious about their computerized record when seeking certain types of embarassing healthcare.

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