Saturday, July 14, 2007

Scrap the national IT plan?

The Archives of Internal Medicine just published an article "Electronic Health Record Use and the Quality of Ambulatory Care in the United States" that assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey (summary here.) The article concluded:

"As implemented, EHRs were not associated with better quality ambulatory care."

The key words are "as implemented" - which, as readers of my other posts about EHR's know, often means "poorly."

This story was picked up by the Rush Limbaugh talk program, that has an audience of perhaps 20 million listeners, as well as the health care blog of the Wall Street Journal in an article entitled "
Computerized Medical Files Not Much Better Than Paper."

This is very bad publicity for this previously-cozy sector.

Cozy for IT vendors, hospital IS departments and high-paid management consultants
who monopolize it, that is, not clinicians, who usually become data entry clerks and whose professional lives are usually made more difficult by often ill-conceived, poorly-designed and poorly-implemented systems, and not medical informatics experts, whose advice is often ignored and who are often marginalized in hospitals as "Director of Medical Informatics" a.k.a. "Director of Nothing."

Further, I can't disagree with most of the points in the following editorial in Modern Healthcare. Modern Healthcare points out health IT issues I have previously written about, including politics, finances, benefit vs. risk, conflicts of interest, simplicity and usability vs. needless complexity, and sums them all up in a concise manner. I think the difficulties of other national initiatives bears out this opinion.

I don't think the medical, IT or political worlds are ready for full electronic medical records yet. The progress in hardware has vastly outpaced the progress in wetware (i.e., grey matter).

Perhaps it is time for stepping back and reconsidering what we are trying to do through computerization.

Modern Healhcare
Jul 12, 2007
Editorial: Scrap the national IT plan

It should be clear by now that unless the federal government mandates a single healthcare information technology platform for all healthcare providers and heavily subsidizes its adoption, we won’t meet President Bush's goal of a national electronic medical-record system by 2014—or anytime after that. As there isn't the political will or the financial resources to accomplish such a national system, other solutions must be found.

The answers won't be forthcoming from the privatized mess left by the Bush administration, which is no closer to success on its interoperable IT system than it was when it started the process three years ago. It has left "control" of the health IT process in the hands of a contentious mix of IT vendors, data-miners, insurers and a handful of healthcare interest groups. The only ones left out are the American people, who might be concerned that invading their privacy may be the signal accomplishment of this concatenation of conflicts of interest. If you don't believe me, read the reports on the process from the Government Accountability Office or any of our past articles on the subject.

Most recently, HHS Secretary Mike Leavitt announced that the American Health Information Community—his advisory panel charged with recommending IT standards—would be privatized by 2009. As Rep. Pete Stark (D-Calif.) has pointed out, if the private sector were intent on having a system of interoperable medical records, it would have done so many years ago, as other leading industries did.

Strong presidential leadership on the issue—particularly in helping providers pay for IT—is needed, but it isn't clear from whom that would come. It may have to be someone who isn't in the Senate now. A bipartisan bill on health IT that is now up for consideration by the full Senate, called the Wired for Health Care Quality Act of 2007, would merely codify the same process we see unfolding in Washington today, including a lack of concern for patient privacy and an overreliance on private industry. One of its key backers is Democratic front-runner Hillary Rodham Clinton.

Why is it that nobody in government recognizes that the sharing of any data should be for medical and research purposes only? Until government absorbs this lesson, we shouldn't have a national IT system.

Not that there is any real threat of one. Only about 10% of physician offices have electronic medical records. While hospitals have adopted them at a faster rate, success stories involving the ability to share data across a system are rare indeed. Even pioneering efforts have foundered on physician resistance and technological snafus.

What may be needed now is simplicity, something in short supply when IT experts get together. One thing that stands out is that modest IT success tends to happen in larger, integrated health systems. Doctors operating in small practices, without any formal ties to hospitals beyond admitting privileges, may simply be left behind on the IT front.

Simply digitizing medical records and adopting computerized physician order-entry and decision-support software are huge steps in terms of patient safety and care quality.

In terms of sharing data among unrelated providers, why don’t we try using smart cards, as is being done in a regional health information organization in the New York area? Patients can carry the cards when traveling, and the complete medical record, updated on each office or hospital visit can be downloaded with a simple USB reader.

These and other relatively simple steps may be what passes for healthcare IT, at least for the foreseeable future. It would be more affordable than current plans. National interoperability can wait, at least until there is a national consensus that the needs of patients are greater than the needs of private business seeking to cash in on identifiable patient data.

To that I have nothing to add.

-- SS

1 comment:

Anonymous said...

What a depressing post. Luckily, I disagree about a lack of progress on interoperability. Thanks to advances in ICD-9, Snowmed, and other controlled vocabularies, we are making it easier for disparate systems to communicate and share data. This is a necessary step for EMR vendors to even attempt to make steps toward "playing well with others".