Wednesday, May 27, 2009

Harvard's EMR Justification: We Just Have To Do Something?

I think what I termed "irrational exuberance" over health IT is now devolving into just simple irrationality.

I am unfamiliar with the reasoning employed below (in boldface) by the Harvard researcher, Ashish Jha, MD, MPH (who authored the April 2009 EHR usage survey "Use of Electronic Health Records in U.S. Hospitals" in the NEJM).

From "Cash for Computers", HealthLeaders Media, May 11, 2009. First, my opinions:

... "This forced timeline [by 2014] is a very bad thing. I'm concerned it is going to take an experimental technology and turn it into a train wreck," Silverstein [me - ed.] says. "We need a more gradual process where we can learn from mistakes on a small scale to avoid reproducing them on a large scale ... So now, Silverstein says, healthcare providers are caught between their mission to provide quality care and the financial pressure to install an unproven technology that may threaten the mission.

"Health IT, when it's done correctly, can improve healthcare and reduce costs. But health IT when it is not done well has the exact reverse potential," Silverstein says. "It can impair healthcare, decrease quality, and create other adverse effects for patients. That is the missing element in this discussion."

Then, Jha's:

A need to act

Others aren't so pessimistic. Jha [Ashish Jha, MD, MPH, the lead author of the survey, and an associate professor of health policy and management at Harvard] says hospitals will have five years to establish EHR before federal penalties kick in. And because it involves the federal government, Jha says it's more than likely that those deadlines will get pushed back even further
[not according to ONC chair and fellow Harvard professor David Blumenthal, who as I noted in this post said HIT timelines were "cemented in law" - ed.]

Jha says critics are "missing the point."

"I'm not suggesting EHR is going to be a panacea,
but the one thing that is absolutely true is there is nothing else out there now that has any more political appeal," Jha says. "Everybody agrees, whether you are a conservative, moderate, or liberal, that we have to do something about healthcare. So the one place where we can all come to agreement is we have to do something about electronic records."

$20+ billion and penalties upon already squeezed practitioners and hospitals for non-adoption of expensive, experimental technology is a lot of "doing something.", especially at a time when many are medically uninsured or underserved.

I am also not sure about what point critics are "missing." (Note: I am not a critic, but am a gadfly of healthcare IT mis-design, mismanagement and fraud.)

It appears that reasoning at Harvard has dropped to the level of "we should do it, because we have to do something." Good intentions trump outcomes. Not to make a comparison between HIT and other types of medical experimentation, but it's likely the PI's of the Tuskegee Experiment felt the same way.

Ironically, Harvard is home to Medical Informatics pioneers such as Dr. Octo Barnett, coauthor of the National Research Council report warning that approaches to today's HIT are inadequate.

-- SS


Anonymous said...

Jha's comment criticizing the "critics" of un-approved and experimental HIT equipment is a self-indictment, disclosing his degree of bias. This leads to interesting questions.

Is he biased because he is sucking up to the President (both Harvard men) and to the President's appointees (also Harvard men) now in high places?; or might he be biased because of the funds HIMSS "donated" (as reported by WAPO) to Harvard's foundation, CITL, as part of the program to buy favorable scientific results and economic opinion? I will not ask if Jha has his own foundation or in some other way, is receiving HIT booty.

Are the results that he published believable or might the HIT penetrance be even embarrassingly (for him and Harvard) lower than he reports?

Nurse Triage said...

Thanks for educating us through this beautiful blog.

Andy Stones said...

The new EMR system which government is trying to enforce in all the hospitals and private clinics, is not well established. The government should first sort the problem of EMR technology then enforce them in nationwide hospitals.

John Kaphal said...

I don`t totally agree with Andy about EMR systems. The EMR system which are being used in US are pretty good, there might be some cases in which it has make some errors. I see this as a step forward.

InformaticsMD said...

Pretty good, compared to what?

-- SS