Health IT has problems, but is worth the price

I started working with computers in medicine in 1963. I was a Captain in the United States Army Medical Corps in San Francisco when a Lieutenant Colonel told me to “automate the California Tumor Tissue Registry.”

I said, “Yes, Sir. How would I do that?” He told me to walk across the Presidio parking lot and go into a building that had a big machine in it that is called a computer.

I did that, and for the next three months, I took the information that was on a bunch of 3 by 5 cards and converted that data into punch cards, which were then fed into the computer and out came an automated California Tumor Tissue Registry.

I was hooked and, although never a “techie,” I never stopped finding ways to use computers in medicine. The goal was always better, faster, cheaper.

I remain a strong advocate, and have worked in a string of jobs that strived for that goal. One of the truths I learned early on was “G I G O” — Garbage In; Garbage Out. That has not changed.

There are indeed a huge number of medical tasks that computers can do very well if properly programmed, managed, and utilized. The eminent UCSF academic clinician Dr. Bob Wachter was early in recognizing that there were also significant downsides in applying computers in practice.

Physicians are very smart. They will quickly adopt new technology that helps them get their job done if it does not waste their time.

Most American physicians have dragged their feet on implementing computers into their practices, and with good reasons. But now they should get on with it.

I write this column as it has been announced that 100,000 U.S. physicians and hospitals have signed up for the “meaningful use” incentive program and thus been able to take the government’s money to help automate their organizations.

I think this is good and I praise Dr. David Blumenthal for his major efforts to make this happen.

However, there is another harsh critic worth listening to. His name is Dr. Scot Silverstein, and he seems to have made it his life’s work to call attention to really bad problems that he discovers in this mass move to automation.

Heed his cautions. They are real.

But also recognize that where there is progress, there is trouble; but it can be worth the price.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • Anonymous

    “Most American physicians have dragged their feet on implementing computers into their practices, and with good reasons. But now they should get on with it.”

    Beautiful example of a non sequitur.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Wow! There’s something to be said for extreme statements, whether right or wrong.

    Yes, over 100,000 “physicians and hospitals have signed up for the “meaningful use” incentive program”, but there’s a long way before the signatories will be “able to take the government’s money”.
    As of October 31, only 5,805 eligible providers and 235 hospitals received government money. Will the rest of the 138,570 “signed up” providers and hospitals achieve Meaningful Use and get their money? Eventually they might, but they haven’t just yet.
    https://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp#TopOfPage

    As to the other lunatic extreme, do EHRs kill people? Probably, but every single item used in medicine can be shown to have killed people at one time or another, depending on how you define “killed”. Do more people get harmed where EHRs are present, compared to where they are not? There are no conclusive studies to that effect and there are no conclusive studies showing the opposite either. There are not very good studies at all, but if mass murder was occurring, we would have probably known by now.

    The problem with EHRs is that, currently, they don’t deliver on the “better, faster, cheaper” goal very well. At least not from the perspective of those who are asked to pay for them. That said, I agree that EHRs have become part of the cost of doing business whether you like them or not. The only reasonable question to ask is how to go about minimizing the cost and the trouble.

  • Anonymous

    I, for one, am really tired of seeing the garbled trash this guy writes.

  • http://www.facebook.com/people/Joe-Ketcherside/100000137792301 Joe Ketcherside

    I agree with the author. It is time to stop waiting for Godot. We did not move from horse and buggy directly to our current cars. We started with the Model T and made it better through use and iterative improvements. The technology is not perfect, but there are ample studies that demonstrate it can be better than the status quo.

  • S Silverstein

    My further thoughts on these issues are at http://hcrenewal.blogspot.com/2011/11/george-lundberg-promise-of-health-it.html

    To those who think Dr. Lundberg is saying “full steam ahead” considering the state of today’s health IT, you are wrong.  He is saying “heed my warnings.” 

    The technology as it exists today is frequently dangerous, the most recent example being the creation of tens of thousands of erroneous prescriptions that could never happen with paper (http://hcrenewal.blogspot.com/2011/11/george-lundberg-promise-of-health-it.html).  My own mother was maimed and died from the toxic effects of today’s health IT (http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=diary). 

    The recent IOM report is also explicit on this point of health IT risk, and on the worse point that due to impediments to information diffusion, we don’t even know the magnitude of the risk.

    To those industry insiders who praise the technology as if there were no downsides, I strongly suggest you be prepared to defend your statements in court in coming years.   For example, your statements might very well be used against your companies as an example of corporate negligence when patients become injured due to problems with today’s EHR systems.

    Scot Silverstein, MD 

  • Anonymous

    I agree with the use of computers.  There can always be a downside to everything; however I feel we are on a the verge of some very powerful tools.  Healthcare Analytics!  The day of making administrative decisions based on gut is gone and with readily available data – due to EHR/EMR implementation – a new frontier lies ahead.  Now physicians, hospitals, surgery centers et cetera can use that data to recoup money lost implementing their EHR system.  Utilizing data will enable improvements in patient quality care and satisfaction, cut costs, improve employee efficiencies, increase quality pf preventive care, manage risk and predict patient willingness to pay – just to list a few.

    • S Silverstein

      “There can always be a downside to everything” – sure, not a big deal.  Your views are, in fact, nihilistic and profoundly alien to medicine.

    • Anonymous

      “Utilizing data will enable improvements in patient quality care and satisfaction, cut costs, improve employee efficiencies, increase quality pf preventive care, manage risk and predict patient willingness to pay – just to list a few”

      There’s no evidence supporting any of these claims. You’re welcome to your fantasy world, but don’t expect me to spend much time there.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Let me clarify a couple of things here, as opposed to elsewhere:

    1) I have no sympathy for McCarthyism in public debate
    2) I believe in, and I have always advocated for, full FDA regulations of EHRs, most recently here: http://onhealthtech.blogspot.com/2011/11/iom-report-on-health-it-safety.html
    3) Just because people forcefully say that EHRs harm people, doesn’t mean that they actually do. It doesn’t mean that they don’t either. It pretty much doesn’t mean anything.
    4) People are harmed daily, and to great extent, by FDA approved drugs and devices, and people are harmed and die daily, through care provided on paper.
    5) Errors are now made, and will continue to be made with or without EHRs. The few studies that do exist are indicative of little or no improvement due to EHR introduction. There are no studies showing significant increase in error rates, or large scale injuries, due to EHR, although there is anecdotal (yes, anecdotal) evidence of errors and also limited evidence of improvements.
    6) The main problem with EHRs is that there is no tangible return on a rather large investment (both cash and productivity) for most buyers at this time.

  • gray_ed

    Administrative data processing has been part of healthcare for decades, as it has been in many industries.  Computing power also has made healthcare research easier, I can’t imagine doing statistics on paper.  What I think is lost on many is that once you step into the realm of caring for the patient, it is a whole different ball game because the stakes are morbidity and mortality.