My wife handed me the Atlantic article Paging Dr. Luddite. I felt like I'd die if I had to read yet another article gushing over the wonders of electronic health records and all they are going to do to save health care. I grit my teeth and read it.
While the title imples that the main obstacle to better health care are those luddite doctors, the article is somewhat better rounded. Sure, there are Luddite doctors resisting EMR adoption, but the real story is more complex. Much of the current crop of health information technology falls woefully short of the functionality we need.
Everywhere we turn we're given glimpses of the promised land through the lens of those infatuated with technology:
- No matter where you show up, the health care system will have your totally secure records at hand.
- No more unnecessary or duplicate tests - every part of the system will be working off the same data set.
- Patients will be able to communicate their needs via email, secure messaging, video.
- We'll finally be able to roll out standards so that everyone gets the exactly the care they need.
Puh-leeeze! Some people been drinking the PR koolaid. Time for a dose of reality:
- Most health information technology solutions do not communicate with other vendor solutions, so the silos are still in effect.
- In spite of their own hype, most elecronic health records are trumped up billing engines (as the Atlantic author correctly pointed out) and do not enable the kinds of chronic disease tracking the health delivery system desperately need to better help their patients (sure, they all say they do, but talk to the dissapointed and frustrated practices desperately trying to get reports out of most of them and you'll hear a very different story).
- The impediment to emailing and other virtual communication with doctors is not the electronics - it is a payment system that will not support this mode of communication.
- Guideline driven standards of care are mostly based on studies of people with single conditions and exclude the majority of people with chronic conditions, leaving open the question of best practice standards for the bulk of people who have more than just one diagnosis or condition.
I spent last week with a rural community health center network. They are one year into implementing a whiz-bang EMR with a great national reputation.
I listened with horror but not surprize to the woes of the senior clinical management team as they told me that their new and very expensive EMR forced them to run separate reports (from scratch) for each of their nine clinics, separate reports from scratch for each variation in the drug warfarin (there are many), and how the vendor "help desk" has crashed their system multiple times when they come in to "help." A recent crash lost an entire week of laboratory data which must now be entered anew.
They are unable to get a clean and accurate list of women who are due for a Pap test. This is due in part to the arcane and difficult workflow processes embedded in the EMR that makes it difficult to use in real time with patients, and in part due to the fact that (like almost every EMR creator) the makers are clueless about serving the real-world needs of practices that want to better manage population health.
And this is one of the "good" EMRs getting all sorts of accolades from folks in D.C. who think that EMRs are going to revolutionize care.
Electronic records hold immense promise. We need good technology to help us manage oceans of data and help our patients get the care they want and need. I want to have one that does the things described in this and all the other articles touting the benefits of technology in health care. Too bad most of the current crop doesn't deliver on the hype.
