Wednesday, April 16, 2014

CMS does not have any information that supports or refutes claims that a broader adoption of EHRs can save lives?

If this is true, the EHR hyper-enthusiasm problem is even worse than I believed.

From the April 2014 newsletter of the American Association for Physicians and Surgeons (, an organization that is dedicated "to preserving the sanctity of the patient-physician relationship and the practice of private medicine":

CMS Claims to Have No Information on EHRs

On Mar. 14, 2014, the Office of Strategic Operations and Regulatory Affairs of the Centers for Medicare and Medicaid Services replied to a Freedom of Information Act (FOIA) request sent Apr. 4, 2012:  The American Recovery and Reinvestment Act of 2009 (ARRA) created the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  While our Office of E-Health Standards and Services works to implement the provisions of the ARRA, we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives."

However, that doesn't stop our government from spending billions of taxpayer dollars on them, when, in fact, we do know of harms they cause.  One can reasonably assume their primary interest is in bookkeeping.

With FDA, it's even worse.  Rather than stopping at admitting they simply don't know due to admitted impediments to knowing, they simply leap to a conclusion that the technology is of 'sufficiently low risk' not to warrant their regulatory attention, even if such systems meet the statutory requirements to be a medical device and thus fall under the Food, Drug & Cosmetic Act.

See my Apr. 9, 2014 post "FDA on health IT risk: We don't know the magnitude of the risk, and what we do know is the tip of the iceberg, but health IT is of 'sufficiently low risk' that we don't need to regulate it" and its ten-point (and non-comprehensive) summary of risks:  Another FOIA request is surely needed...

More generally, I know from personal development and implementation experience that when "done well", that is, when good health IT and good implementation practices are offered and with patient safety as a priority, health IT can save lives and improve care.  It's just that the commercial for-profit health IT sector does not meet those expectations, due largely to its leadership model from the merchant-computing culture.  Instead, bad health IT is the norm.  From my academic site at

Good Health IT is IT that provides a good user experience, enhances cognitive function, puts essential information as effortlessly as possible into the physician’s hands, can be easily, substantively and cost-effectively customized to the needs of medical specialists and subspecialists, keeps eHealth information secure, protects patient privacy and facilitates better practice of medicine and better outcomes.

Bad Health IT is IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.

 I am seeking source material from the AAPS and will post it.

-- SS

April 26, 2014 Addendum:

Below is the letter to AAPS from CMS.  Click to enlarge.

CMS:  "we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives."  [But let's spend hundreds of billions of dollars anyway.]  Click to enlarge.

An additional thought:

While CMS may "not have any information that supports or refutes claims that a broader adoption of EHRs can save lives", they do have (or should have made it their business to have) information that EHRs cause harm and take lives (e.g., via FDA at , ECRI at and others).

-- SS


Anonymous said...

More proof that these devices, at present, are meaningfully useless.

Anonymous said...

So, if it doesn't save lives... how about time or money? #crickets

Steve Lucas said...

From the Great White North we find that when EMR’s are in trouble we hire family, always a good solution.

What could go wrong?

Steve Lucas

InformaticsMD said...

Anonymous April 16, 2014 at 9:47:00 AM EDT:

That link is only available to Medscape subscribers.

Here are the first few paragraphs:

Medscape Medical News
Meaningful Use Not Correlated With Quality in Study

Ken Terry
April 14, 2014

Showing meaningful use (MU) of electronic health records (EHRs) was not correlated with performance on clinical quality measures, according to a new study published online April 14 in JAMA Internal Medicine.

The study, one of the first of its kind, was performed at clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts. It compared the quality scores of 540 physicians who achieved MU with those of 318 physicians who did not. The healthcare organization computed quality scores on MU measures for all of the 858 physicians, but only some of these physicians met all of the criteria for the government incentive program during the 3-month study period.

Lipika Samal, MD, MPH, from the Division of General Medicine and Primary Care, Brigham and Women’s Hospital, and colleagues looked at 7 metrics for 5 conditions: hypertension, diabetes, coronary artery disease, asthma, and depression. "[MU] was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures," the authors state.

-- SS

InformaticsMD said...

Steve Lucas:

from that link, the usual and customary has already gone wrong:

The troubled agency was the subject of a scorching report in 2009 by then provincial auditor general Jim McCarter. He estimated $1 billion had been wasted in a botched attempt to get a digital health record system up and running.

McCarter documented an agency bogged down in consultants, paying excessive bonuses and expenses.

That's $1 billion that could have been spent on better purposes - like providing care for the underserved.

-- SS

Steve Lucas said...


Remember that $1BCD figure is for Ontario only, and the meter is still running.

Steve Lucas

InformaticsMD said...


Clearly in health IT, money is of arboreal origin.

-- SS