Like most pediatricians I’m not accustomed to giving bad news, and I try to keep these columns balanced and hope to avoid sounding too curmudgeonly. But, this week I am compelled to share two troubling reports that slithered across my desk. Neither came as a surprise to me, because as a card-carrying optimist I have continued to hope that my unfortunate experiences with electronic medical records were not the norm.
The first is an opinion piece that appeared in the Wall Street Journal of Sept. 17, 2012, titled "A Major Glitch for Digitized Health-Care Records" by Stephen Soumerai and Ross Koppel, Ph.D. Mr. Soumerai is a professor of population medicine at Harvard Medical School, Boston, and Dr. Koppel is a professor of sociology and medicine at the University of Pennsylvania, Philadelphia. Their conclusion is that there is little evidence to support the promises of the federal government and information technology vendors that the widespread adoption of electronic medical records will save money and lives. They observe that health IT software "is generally clunky, frustrating, user-unfriendly, and inefficient."
They cite a study done by faculty at McMaster University in Hamilton, Ont., titled "The Economics of Health Information Technology in Medication Management: A Systematic Review of Economic Evaluations" (J. Am. Med. Inform. Assoc. 2011 [doi: 10.1136/amiajnl-2011-000310]). Of the 36,000 studies evaluated, the researchers found 31 that examined claims of cost-savings. With some isolated exceptions, IT systems had neither saved money nor improved health care. For example, several studies found that doctors overrode drug interaction alerts between 50% and 97% of the time. That pretty much covers my average rate for overrides.
Mr. Soumerai and Dr. Koppel also cite studies from the Indiana University School of Medicine that found no savings and an increase in cost of $2,200 per physician with the introduction of electronic health records (EHRs). One study did show a "small but statistically questionable savings of $22 per patient per year."
On a smaller and more personal scale is Medscape’s "EHR Report 2012 - Physicians Rank Top EHRs" that a colleague e-mailed me. This survey was performed in June 2012 and included more than 20,000 physicians representing 25 specialties. One of the most striking findings was that although in a 2009 survey more than a third of respondents said they had no plans to include an EHR system in their practices, in 2012 more than 80% of physicians were using or in the process of installing EHRs.
Do you think that the government’s financial incentives have had anything to do with this dramatic shift in attitude? If we look back at the evidence that Mr. Soumerai and Dr. Koppel have accumulated, this sudden shift in plans couldn’t possibly result from testimonies by EHR users who are thrilled with their financial experiences.
In the Medscape survey of current users, 26% reported that EHRs decreased their productivity and only 6% said it increase their revenues. Nearly a third of the respondents thought that their EHR system had a negative impact on the doctor-patient relationship. Of this subgroup, 82% reported that the EHR resulted in less eye contact, and 75% thought it resulted in less conversation time.
What do these numbers tell us? First, physicians tend to be rather poor business people. When offered a subsidy, they don’t ask the obvious question, "What will this do to my bottom line?" Second, many of the people who design software (even those who may have an MD after their names) don’t understand the nuts and bolts of day-to-day clinical practice.
The tragic thread through this whole EHR mess is that if properly conceived and implemented, EHRs have the potential to save both money and lives. However, the federal government made a serious error in failing to demand unified standards. Left to their own devices, the vendors haven’t cooperated with each other, and chaos is the result.
I remain hopeful that if Apple can do what it has done with the iPhone and the iPad, then we have the people and smarts to make EHRs fulfill the promises that are currently missing in action.
Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.