I wrote here about an "irrational exuberance" regarding electronic medical records (EMR's). Well, here's an example of the escalating irrational exuberance, Don Corleone-style.
From AHA News:
Leavitt: Medicare should link higher physician payments to health IT
Any legislation to stave off a reduction in Medicare reimbursement rates for physicians in 2008 should require physicians to implement health information technology to be eligible for higher payments, Health and Human Services Secretary Mike Leavitt said yesterday. “Such a requirement would accelerate adoption of this technology considerably, and help to drive improvements in health care quality as well as reductions in medical costs and errors,” Leavitt said. “I’m confident that many members of Congress are of a like mind on this issue and I will actively work with them in the near future.”
From my introductory essay at my web site "Common Examples of Healthcare IT Failure":
...the use of electronic health records, without a major change in health care delivery, would not significantly reduce overall health care costs, the director of the Congressional Budget Office said at the release of the agency's 2007 report on long-term health care spending. Peter Orszag, CBO's director, said that according to data from the report, the return on investment for EHRs "is not going to be as substantial as people think."
... With regard to electronic health records ( EHRs ), a research article in the Archives of Internal Medicine entitled “Electronic Health Record Use and the Quality of Ambulatory Care in the United States” (Arch Intern Med. 2007;167:1400-1405, link to abstract here ) reached what to many was a counterintuitive and paradoxical conclusion. The authors examined electronic health records (EHR) use throughout the U.S. and the association of EHR use with 17 basic quality indicators. They concluded that “as implemented, EHR’s were not associated with better quality ambulatory care,” and were bold enough to publish their findings, sure to be unpopular in the health IT industry.
These findings are indeed troubling. An EHR for small-group and solo-practice physicians costs $44,000 per physician, and generates an average ongoing $8,500 per year in annual costs , ACP president Lynne Kirk, MD told the house Subcommittee on Regulations, Healthcare and Trade of the House Committee on Small Business in October 2007. "The business case does not exist to make this kind of capital investment," Kirk told the Subcommittee.
Contrast that with Leavitt's actual words:
The benefits of utilizing health information technology for keeping electronic health records and other purposes are clear. This technology will produce a higher quality of care, while reducing medical costs and errors, which kill more Americans each year than highway accidents, breast cancer or AIDS. Congressional leaders are working on legislation to address Medicare's physician payment system, staving off a reduction in reimbursement rates that is set to take effect in January and is required by law. In my view, any new bill should require physicians to implement health information technology that meets department standards in order to be eligible for higher payments from Medicare.
Regarding EMR exuberance, there's science, then there's fiction -- and then there's science fiction. See additional references below.
I remind that outright coercion further escalates the battle of the technologists vs. those with sociotechnical wisdom regarding health IT, i.e., those who understand that it's not wise to shove semi-proven (or unproven) information technology down people's throats.
Also, one wonders, say, why airline pilots are not forced to purchase, out of their own pockets, computers in their cockpits designed to prevent pilot error or collisions, but that in testing actually often doesn't work, or just makes piloting a plane harder without strongly proven benefits.
Oh, wait ... pilots could just refuse to fly until the systems worked!
Oh, wait ... pilots can just go to their union steward and complain, and then the union can call a strike and shut down the airlines!
Oh, wait ... pilots can just leave and go fly cargo planes in the Caribbean!
But to doctors, the government can make an "offer they can't refuse" with impunity.
This raises a fundamental issue. Physicians can't even associate and share information such as on setting fees or compare their managed-care contracts due to antitrust laws, and have basically lost control of their profession. EMR's are increasingly being shoved at them with the expectation that the costs and increased efforts required to use them will be donated, gratis, and the data from the EMR's will likely be used by payers to increase their own profit further, at physician expense.
Now, the concept of outright "ransom" is being raised -- purchase and use EMR's, or else we will cut your (already not exactly overly generous) Medicare reimbursements!
I am, however, unaware of any laws against physicians, especially those in private practice, boycotting purchase and use of EMR's, as a political statement at the very least. [addendum - see comments section for more discussion of this point - ed.]
Perhaps that's a first step towards regaining control of the profession.
Some additional references. EHR as panacea: Science, or science fiction?
- "Sociotechnical Issues in Clinical IT: Common examples Healthcare IT Difficulty" by this author. link
- It Ain’t Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs. Health Affairs, 25, no. 4 (2006): 1079-1085 (link)
Abstract: Electronic health record (EHR) advocates argue that EHRs lead to reduced errors and reduced costs. Many reports suggest otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums. As interest in patient-centeredness, shared decision making, teaming, group visits, open access, and accountability grows, the EHR is better viewed as an insufficient yet necessary ingredient. Absent other fundamental interventions that alter medical practice, it is unlikely that the U.S. health care bill will decline as a result of the EHR alone.
- Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005 Mar 9;293(10):1197-203. (link)
- Pessimism, Computer Failure, and Information Systems Development in the Public Sector. (Public Administration Review 67;5:917-929, Sept/Oct. 2007, Shaun Goldfinch, University of Otago, New Zealand). Cautionary article on IT that should be read by every healthcare executive documenting the widespread nature of IT difficulties and failure. link to pdf
- Unintended consequences of information technologies in health care--an interactive sociotechnical analysis. J Am Med Inform Assoc. 2007 Sep-Oct;14(5):542-9. (link)
- Expected and unanticipated consequences of the quality and information technology revolutions. JAMA. 2006 Nov 22;296(20):2439; author reply 2439. (link)
- Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument. Int J Med Inform. 2007 Oct 9. (link)
- U.S. Court In Illinois Declines To Limit Damages In Hospital's Claim Against Health Record Information System Supplier - ref: Rush Univ. Med. Ctr. v. Minnesota Mining and Manuf. Co., No. 04 C 6878 (N.D. Ill. Nov. 21, 2007).
- Adverse Effects of Information Technology in Healthcare. The Knowledge Center at this link presents a collection of taxonomized information assets on the adverse effects of information technology in its application to healthcare.
- ”Electronic Health Records Raise New Risks of Malpractice Liability” (link to PDF) by attorney Joel B. Korin and Madelyn S. Quattrone, ECRI Senior Risk Management Analyst, the emerging legal issues are summarized.
- Bad Health Informatics Can Kill. This site contains summaries of a number of reported incidents in healthcare where IT was the cause or a significant factor. It comes from the Working Group for Assessment of Health Information Systems of the European Federation for Medical Informatics (EFMI)