In addition to my post today "EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals Suggest the True Value of Health IT Has Been Grossly Exaggerated" (http://hcrenewal.blogspot.com/2014/06/ehr-exceptionalism-debunked-care.html), here's another.
I won't comment on this very much:
May 30, 2014
Is Electronic Charting Less Efficient Than Paper Charting?
Daniel J. Pallin, MD, MPH reviewing Ward MJ et al. Ann Emerg Med 2014 Jun.
Operational performance was similar before and after computerization at 23 community emergency departments.
The federal government has provided $17 billion in incentives to computerize healthcare. The potential benefits include improved error checking, decision support, better billing, and more data for research. However, some research has suggested that going paperless adversely affects productivity.
To further examine this issue, investigators measured operational efficiency 6 months before and 6 months after implementation of an electronic health record system at 23 community emergency departments. No significant differences between the two time points were found in all efficiency factors that were measured, including time to provider, lengths of stay, walkouts, patient satisfaction, patients seen per provider per hour, and significant return visits.
Ward MJ et al. The effect of electronic health record implementation on community emergency department operational measures of performance. Ann Emerg Med 2014 Jun; 63:723. (http://dx.doi.org/10.1016/j.annemergmed.2013.12.019)
One might seek to get better results for their $17 billion than, at best, parity to paper.
Finally, the reader comments at that post suggest ED physicians are the ones helping foot the bill. As one commenter put it:
"Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or discharge. So we just chart later and go home later."
We as patients certainly should not find a development like that desirable.
Note that in my work as a hospital Chief Medical Informatics Officer (CMIO) I recommended simple document imaging solutions for risk-laden ED's (where charts are usually short) to capture and make the paper chart content available anywhere/anytime ... not full-blown digital electronic medical records systems.