Originally published in HCPLive.com
by Alberto Borges, MD
For those interested in health information technology, there is now an excellent, new, powerful article about this topic entitled, “Can Cleveland Clinic Be a Model for Digital Medicine?” where they discuss how this hospital system has failed to recoup their $100 million investment to date.
Here is my take on the Cleveland Clinic story, beyond the fact that they failed to get a cost savings:
Certified EHR (c-EHR) systems don’t intercommunicate. The Cleveland Clinic healthcare system utilizes one certified electronic health record (c-EHR) that all doctors are able to access for free. Same goes with the VA Health System, the Mayo Clinic, and the Kaiser Permanente. Some centers like Partners Healthcare make an EMR that they put together available for a nominal amount. Note that none of these centers are able to communicate outside of their own big healthcare networks.
What President Obama and other politicians including former President Bush want is for physicians to purchase amoung a group of about 100 certified EMR systems that have an average cost of $33000.00. They want these systems to talk to each other, which today remains a pipe dream. On top of that they want these physicians to “significantly use” their EMRs in a manner that requires reporting and extra patient encounter time that I calculated to cost about $60000.00 per year. This will essentially cause the eventual extinction of the small physician office.
The claim that c-EHR systems “increased quality” has not been proven. In 2006, only 73 percent of the elderly and infirm who needed regular pneumonia vaccines were getting their shots. Three years later, the rate was 90 percent, according to the hospital’s figures.
The EMR can be an excellent tool to make the practice of medicine easier for physicians. In my main admitting hospital, the Virginia Hospital Center (VHC), all I have to do is log in to get not only the results of an X-ray, but to see the actual scan. This makes me more efficient. To claim that this translates to better patient results over paper has yet to be proven, as before I obtained similar results by calling or by using their “basic” EMR with all the results available online (without the actual X-ray picture).
The only way to actually show improved outcomes/quality through a costly certified EHR is to have a prospective study using paper method as a “control” group and to actively track vaccine shots by placing a notice on all charts (like is done at my hospital where over 90% of shots are administered), then do the same using a certified EHR. Using historical controls to show “increased quality” is not the scientific method, and the Cleveland Clinic should know better. When it has been done in the past, s.a. in one Children’s Hospital, when the data was analyzed, the c-EHR arm showed an increased death rate. According to the U. S. Pharmacopeia’s 5th annual study of medication errors, data input errors far exceed handwriting errors in 2005, at 27711 vs 6134. They found that data input errors introduced 22 new ways that EHR software systems can increase medication errors.
This translated into extra work for the doctor… to follow up with patients. It is costly to turn doctors into secretaries. Now, if they are willing to pay for it, great. The HITECH Act’s $44,000.00 doesn’t cover this type of extra work.
The massive cost of the c-EHR can bankrupt healthcare. These issues have hit close to home for me. One hospital that I admit to (Inova Fairfax Hospital) spent a lot on GE Centricity. I have to admit, their ER looks pretty with computers everywhere and flat screen TVs on the walls tracking patient flow. But does that increase quality? I don’t know. They’ve been trying to get all of their 1,500 staff to buy a $30,000.00, 5-year license of GE Centricity. What a hoot of a profit that would be for GE, huh?
The other hospital where I admit to (Virginia Hospital Center, or “VHC”) has purchased Sieman’s Sorian, which cost them $14 million, shortly before Sieman’s went into financial trouble leading to 16,000 layoffs. To date, we have yet to see the full implementation of this EMR. VHC seems to have lost, last year, as much as $18 million, which may have been the impetus to cut hospital admission times by an average of some 3-4 days per admission. What does this do to the actual quality of patient care when I have to discharge a patient on IV antibiotics who needs to give himself the antibiotics for 8 of the planned 10 days? Will the Sorian EMR help him if he has an acute drug reaction at home without anyone to turn to? Or how about if the hospital closes its doors, like what the other 3 hospitals have had to do in the past 10 years—what does that do to “quality” of healthcare in Arlington, VA when there are no local hospitals left to care for the citizens of the town?
The take home message is that c-EHR systems will not only fail to save money, but may actually increase costs tremendously, overburdening an already bloated troubled healthcare system. c-EHR systems have not been demonstrated in a truly objective manner to decrease errors and increase quality, and in some studies, have shown exactly the opposite. If our elected officials want physicians and hospitals to invest into the c-EHR propaganda, we need further studies and proof that in their respective environments’ costly, workflow disrupting c-EHR systems really are worth the investment.
Alberto Borges is an internal medicine physician who blogs at The HIT Realist.
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