Barack Obama wisely wants to spend money to modernize the country’s antiquated health records system.
But is throwing money on old, flawed technology to right course of action? Emergency physician Rick Peters (via David Catron) thinks not, as the spread of first-generation EMR programs will simply lead to “across the board loss of clinical efficiency, a loss of productivity and a counterintuitive increase in the number of personnel, and increased clinical and administrative errors due to system and user interface complexity.”
Today’s electronic record systems are not ready for prime time. They do not talk to one another, and a propagation of fragmented systems may make things worse than they already are.
Like bailing out the Big Three automakers, an infusion of federal dollars into the current crop of programs will only stifle innovation that’s sorely needed to make electronic record systems truly useful.
Related posts:
- Will the benefits of digital medical records only be seen in large, integrated health systems?
- Electronic records and economic sense
- Op-ed: Why doctors still balk at electronic medical records
- The New York Times finally gets it on electronic medical records
- Poll: Will electronic medical records really save money?
- My take: Funding geriatrics, electronic records, CT-cardiac scans
- Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem
{ 10 comments }
I’m not quite sure why the VA’s VistA is so often left out of these discussions. It’s development was done entirely in-house so it is available to the government (and as freeware to any physician who wants to find their own IT support).
This money could easily be used to develop centralized IT support available to any physician who adopts the software. The program isn’t beautiful, but it’s inter-operable and extremely functional.
Given the way that most Feasibility Analysis processes are structured for IT adopting a system like VistA would almost never turn out to be cost effective.
You have to take legacy costs and conversions into account, as well as factor in the issues of software that was written over a long period of time in specialized or older software languages.
VistA is a non-starter because nobody can make money on it.
What the government should do is set standards on data formats, security, interconnectivity, etc to allow the fixes that are needed before widespread adoption will take place, and then provide real motivation to use them – how about using the ‘Gore Tax’ money on wiring rural health care facilities (including doctors offices)?
i have eclinicalworks and have used the VA’s program and didn’t like it at all. I don’t find it great other than you can get reports from all over in the system but i imagine this is possible in any large corporate network emr like kaiser..
We aren’t in the universe alone. We need to look at the debacle in Britain before making any decisions. I don’t know how good Vista is, but agree with the money part of it. Much of the cheerleading for health IT comes from the IT industry (I work for one them now) who are salivating at the hundreds of billions they think this will make for them-the more costly the better. They are counting on it pulling them out of the slump they have been in since the i-net bubble broke.
I could not agree more. A big push into a HC IT spend with EMR structured and engineered the way they are would be a waste of money better spend elsewhere. My latest blod piece on this was picked up by the VC space in Seattle.
http://tinyurl.com/87muzb
The problems with the current state of EMR is bad. Prehospital software is much more simple.
Since government money will probably only encourage the acceptance of faulty systems, that is another good reason to wait.
Which will prove to be the bigger boondoggle in 2009 – EMR’s or ICD10?
How much longer can US docs survive the seemingly endless stream of unfunded mandates that have more to do with data tracking than patient care?
The government’s ‘investing’ money in EMR is seen by many as a way of solving the US’ health problems. One thing the government knows how to do well subsidize failure.
The current batch of EMR software is pretty bad, particularly from a User Interface perspective. This front end problem can be solved fairly easily, using some common sense, open source software, and the customization capabilities that the newer Web 3.0 technologies have demonstrated and proven.
However (always one of these), the main problem is the back end, often called the ‘plumbing’. Every interested entity involved in health care, and there are a lot of them, wants their data in their own way. Even when these ways are stable for a while, the entities’ internal business rules and workflow processes are opaque and arbitrary, and where managed seem to be more concerned with maximizing revenue (increase enrollments) and minimizing expenses (deny more claims).
The failure of HL7 and its various alternatives to achieve a transparent standard of information exchange is made even worse by the complexities of the billing capturing methods such as ICD 9/10.
All these things do is perpetuate a never ending back office problem. Completely ignored are the needs and requirements of the patient/customers. Driven an Edsel lately?
Chuck Brooks
FutureWare SCG
I agree with Chuck. I have been working with HL7 data feeds for the past year now and there are simply a lot of frustration instead of benefits.
One way for the government to EMR might be to hold some sort of contest/competition for people to build the best EMR system instead of simply handing out the money. That way we will stimulate entrepreneurship while changing health care system.
On the same topic, the amount of money charged by the drug companies for their drug dictionary is ridiculous.
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