Op-ed: Why doctors still balk at electronic medical records

The following op-ed was published on October 1st, 2008 in the USA Today.

Despite the fact that we can complete our taxes and perform complex financial transactions digitally over the Internet, medical records have faced an impasse preventing a transition to the digital age. Patient charts are still paper-based in most doctors’ offices across the country.

President Bush’s goal was for every American to have an electronic medical record by 2014. Both presidential nominees Barack Obama and John McCain’s health reform plans include language that modernizes our health information system.

Despite the advantages of computerized records — including reduction of errors, improved preventive care and potential health care cost savings — adoption of the technology remains distressingly low.

The New England Journal of Medicine recently found that only 13% of physicians had made the transition to an electronic record system. The primary reason is financial. Upfront costs — which include purchasing servers, computers and software — can be as high as $36,000 per physician.

In addition, the learning curve for these programs is steep, increasing the amount of time a physician spends per patient.

For their efforts, doctors receive only 11% of the savings from electronic records, with most of the savings going to health insurance companies and the government.

In today’s environment of rising office and malpractice costs, the decision for doctors to adopt digital records is fiscally unpalatable. David Brailer, former national health information technology coordinator in the Bush administration, puts it best: “The doctors bear all the costs, and others reap most of the benefit.”

Furthermore, today’s electronic record systems are riddled with problems. Many programs boil the patient encounter down to a series of “yes” or “no” questions that are then entered into the software. The resulting computer-generated notes are almost devoid of useful clinical information.

As Harvard physician Jerome Groopman says, encouraging doctors to ask restrictive questions can suppress open-ended dialogue with a patient, “which can be key to making the correct diagnosis and to understanding which treatment best fits a patient’s beliefs and needs.”

With hundreds of products on the market, few standards exist that would allow them to communicate with one another. Your primary care doctor might use one system, your specialist another and the local hospital a third.

One needs to look at the Department of Veterans Affairs for an optimal model. All of the VA’s primary care physicians, specialists and hospital-based doctors across the country use the same electronic record system. It has played a significant role in the reduction of medical errors, optimization of cost efficiency, and attainment of high scores in preventive care measures.

Like other health indices, the U.S. lags other countries in the digitization of medical records. Modernizing our health information technology will be expensive, with estimates in the hundreds of billions of dollars.

Neither presidential nominee proposes enough financial resources to help doctors adopt computerized record systems. Combined with the dysfunction and incompatibility between the current crop of programs, the goal of universal electronic medical records remains elusive.