Paging Dr Luddite: health information technology, the hype and the reality

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.

Comments

[Hope Hetico RN MHA]

Why Doctors DO NOT Need eMRs?

As a doctor, it seems as though you’re being told by everyone that you need to jump into electronic health records and electronic medical records software; that’s like telling you that you need to manage patients’ records and is so obvious as to be useless advice.

http://medicalexecutivepost.com/2011/02/06/why-doctors-do-not-need-emrs/

We need Patient Collaboration Tools instead!

Dr. David Edward Marcinko MBA
www.BusinessofMedicalPractice.com
[Editor-in-Chief]

[L Gordon Moore]

I wish we had a great open source document describing the specific needs, but a short list would include:
The ability to securely share data (with patient permission) between all silos of health care.
The ability to automate all the administrative hoops and hurdles insurers use to manage costs (eligibility, benefit nuances, co-payment/deductibles, formularies, prior authorization).
The ability to manage individual and population health data with flexible and reliable reporting engines.
Gordon

[www.google.com/accounts/o8/id?id=AItOawliCUaxcPFR6iah6hL63uUOZH05TaPjiJw]

On Paper MRs

Some doctors believe that the idiosyncrasies of hand-written or paper notes do more to convince a courtroom [jury and patient] of their level of involvement than a computerized, cookie cutter, mind-numbingly cloned note or a prompt driven fill-in-the-blank template. Me too!

•www.jblearning.com/catalog/9780763733421/
•www.jblearning.com/catalog/9780763745790/

Why? It is easier to conclude that the doctor was really there; involved, listening and thinking; etc.

IOW: Caring

Dr. David Edward Marcinko MBA CMP™
www.CertifiedMedicalPlanner.com
[Publisher-in-Chief]

[Robert Watkins]

"most elecronic health records are trumped up billing engines"

So true. It is very easy to imagine a usable EMR if it were designed only to improve patient care. However, as long as they have to accomodate CPT/ICD/"coding for dollars" requirements, I'm very pessimistic that they can become more usable. The MU regulations, which are designed primarily to allow data-mining, could well make things worse.

There's a fascinating article in Arch. Int. Med. this month that shows no difference in "quality of care" (as we currently measure it) whether EMRs or paper is used.

[Healthcare311]

Gordon,

your concluding line suggests that you and/or one or more of your colleagues has done a pretty thorough matrixing of capabilities of extant systems. Why not make that analysis available to others to help clarify where the hurdles lie?

When there are open source initiatives that are at least alleging to tackle the performance/cost conundrum you allude to (one humble example - Open MRS: openmrs.org/ ), surely identification of "what doctors really want" in EHR - rather than "what doctors really whine about" - would help provide them a lamp in the darkness?

[L Gordon Moore]

Ha! My bad.
Thanks for catching the bad link. Should be set now.
Gordon

[Healthcare311]

you have to admit it's kind of funny that in an article of this type, your link to the "Paging Dr. Luddite" article is malformed, and maybe too that your typepad configuration does not seem to permit html in replies. Maybe there's a fax #...?

Atlantic article link: http://www.theatlantic.com/magazine/archive/2010/12/paging-dr-luddite/8292/

ok, I'm a mean person ;-)