President Obama has called for the nation’s health care system to adopt electronic medical records ““ a move that he says will lead to 80 billion dollars in savings.
That figure comes from a theoretical study done in 2005. But analysts admit that real-world evidence doesn’t support the claim. For one thing, 100 percent of physicians would have to adopt digital records, while at the moment less than 20 percent of physician practices have made the transition to electronic records.
Computerized medical records have some definite benefits – the potential to reduce medical errors, improve preventive care, and avoid redundant tests.
But, the current generation of systems may actually prevent significant cost savings. They’re geared more to satisfy billing requirements than improve patient care. Most programs make it easier to “upcode.” With a single keystroke or mouse click, programs can make diagnoses more complicated than they really are, or add to a note, with the goal of increasing revenue.
And despite the more detailed charting, there is no data that digital records result in improved outcomes for patients.
Electronic medical records may save money in the future. But for now, it’s simply not the case.
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Related posts:
- Op-ed: Why doctors still balk at electronic medical records
- Medical students who are used to electronic records
- Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem
- The New York Times finally gets it on electronic medical records
- Poll: Should doctors apologize after a medical error?
- Electronic records save money, right?
- Electronic medical records: Expensive . . . and ineffective?
{ 7 comments }
One of the major problems I see with the current push for EMR is that everyone will adopt different software programs, which means that they won’t be able to talk to each other. If the hospital I’m at can’t access the EMR from your clinic, how will we truly realize cost savings? For instance, if I admit someone on a Saturday and believe s/he needs an echo, but s/he just had one last week, I have no way to access that information and I end up repeating it.
All of Sharon’s Points are correct, getting to where the system can really save money I feel is very far away. Not to mention the privacy concerns!!
I go to one physician group that uses electronic records. My chart is always out of date re: current meds and side effects b/c at each visit, the dr cuts/pastes instead of actually writing the correct information and they never bother to go back and update the cut/paste. I’m sure glad this particular doctor’s office’s records won’t be used in an ER if I ever need help because they’re ALWAYS wrong.
But you are challenging this after it has achieved the status of “general consensus” and one which many with influence find advantageous to support:
IT industry for billions of sales
Policy wonks and insurers for the potential to control doctor-patient relationships at the point rather than reactively
Politicians for the ability to promise something for nothing.
The idea that EMR will save money also sells well because it feeds into some of our most powerful biases that have commonly led to wasteful bad decisions:
Excessive confidence in our ability to predict the outcome of our efforts.
A tendency to repeatedly ignore the ubiquity of unintended consequences.
The traditional American confidence in technological solutions.
The general tendency around the world for the last hundred years towards striving for ever greater centralized control and confidence–despite the murderous record of collectivism–that with enough centralized control all problems can be solved.
If electronic medical records end up saving money and improving healthcare it is most likely that this will be an indirect effect of making it easier for clinicians to use information resources such as online textbooks and decision support programs. These are the types of content that clinicians think actually improve care.
My problem with EMR is the substance of the notes themsevlves. The Medical record exists so that health care practitioners can communicate with each other about patient diagnosis and treatment. Therefore, brief problem focused notes with pertanent negative findings is all that should be included. Unfortunately the medical record has metamorphasized from a means of communication between medical professionals to a document meant to justify third party billing. Now to collect a reasonable reinbursement, medical professionals must write extensive notes, saturated with “bullet points” to satisfy the demands of insurance providers. The EMR sells itself less as a means of communication between practitioners, and more as an easy way to create notes geared to satsify insurance billing requirments. Now notes for patient encounters have become reduced standard templates, with checklists to “upgrade” your billing. Now insead of meaningful concise “SOAP” notes we have pages and pages of usless and extraneous information. This is tedious to read! Moreover, wading through volumes of extraneous information, just to discover the core of the patient’s problem is inefficient and frustrating! What will happen is busy practitioners (and we’re all busy) will set aside the EMR and not bother to read the notes, or even worse, be mislead because the template used, stated a pertanent finding that the original practitioner forgot to delete out of the template! We’re all guilty of doing this, whether it be a standard “check list” office note, or the template for an operative dictation you may have set up in your own memory. Think about all the times you’ve written “WNL” in a note without actually doing a complete examination. How will we be able to resist mouse clicking “agree” to a neat detailed templated medical note, full of sound and fury, and signifying nothing.
EMR is a good idea, but can only work if it is designed for medical professionals to communicate, and not to satisfy insurance billing requirements. To do this the notes must be intentionally written by the physician, and kept subsanitive, and not overly detailed or lenghty. Otherwise we’ll end up with a useless glut of extraineous information, that can be sent electronically around the world in an instant. The only benificiaries if the EMR as it is developing will be the trees. Provided nobody decides to hit the “print” button and flood the ward with the same useless information.
The way to solve the problem of TMI in the EMR is to dump the CPT that is driving it–and charge by time like other professionals.
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