While advances in technology—eagerly adopted by doctors and hospitals—are often blamed for high medical costs, there is one type of technology that will supposedly save billions once we “invest” billions in it and force it on supposedly recalcitrant, technophobic doctors and hospitals: health information technology (HIT), including the electronic medical record (EMR) and computerized physician order entry (CPOE).
“Faith-based cost control” is the term used by Dr. Jon Oberlander in a “Perspective Roundtable: Health Care and the Recession,” offered by The New England Journal of Medicine in January, 2009.
The “stimulus” package provides between $44,000 and $64,000 for physicians who acquire an EMR and demonstrate “meaningful use.” However, “the price is dwarfed by the problems [an EMR] causes the office,” stated Evan Steele, CEO of SRS Soft, which provides a less complex alternative. If a specialist who bills $750,000 a year loses 5% of her productivity dealing with the computer system, she loses $162,000 over 5 years (Physicians Practice, April 2009).
Even the vaunted Veterans Administration system has major problems. An 8-year, $167 million project was not able to develop acceptable scheduling software. The military’s AHLTA system is so slow, unreliable, and cumbersome that clinicians spend 40% of their time inputting data, causing a “near mutiny” (CPR #172, 4/3/09).
For ₤12.7 billion the UK still does not have a national health information technology system, but rather an HIT quagmire, some of it caused by U.S. HIT vendors, writes Dr. Scot Silverstein to the Wall Street Journal.
The province of Ontario just created a new agency, eHealth Ontario, to replace Smart Systems for Health Agency, which spent $647 million without showing any noticeable results. The new agency is supposed to provide EMRs for all citizens by 2015. The province has just hired a consultant to examine whether eHealth Ontario is spending too much money on consultants (Canada Free Press 6/9/09).
In the U.S. also, “most big health IT projects have been clear disasters,” says Dr. David Kibbe, senior technology advisor to the American Academy of Family Physicians. And it’s not just the money.
One U.S. pharmaceutical data base found 43,372 medication mistakes, or about 25% of the total reported in 2006, that involved computer technology: flaws in data entry, inadequate software, and confusing screens. In 2006, Children’s National Medical Center in Washington, D.C., found an eightfold increase in dosage errors for high-risk medications (Terhune C, et al., Business Week 4/23/09).
A 2005 study by University of Pennsylvania sociologist Ross Koppel found 22 circumstances in which the software boosted the probability of error. Doctors also suffered from “alert fatigue” from endless false alarms about minor drug interactions.
“If drug companies sold products with this quality level,” states Dr. Scot Silverstein, “it would be a scandal” (Forbes 5/11/09).
HIT vendors shift liability to users and insert contract language that keeps them from learning of serious faults (Koppel R, Kreda D, JAMA 3/25/09).
“There is a dearth of data on the incidence of adverse events directly caused by HIT overall” (Joint Commission. Sentinel Events Alert, Issue 42, 12/11/08). Among many potential problems are “dangerous workarounds” necessitated by counterproductive technology.
Potential benefits have been greatly exaggerated. Large randomized controlled studies in both the U.S. and Britain have found that EMRs with computerized decision support “did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma” (Washington Post 3/17/09).
As a direct consequence of the EMR and pay for performance (P4P), the veracity of the clinical record is compromised, write David J. Gibson, M.D., and Jennifer Shaw Gibson (“The Case Against the Electronic Medical Record,” MedicalTuesday.net). Reported data may be “dry-labbed,” and, once entered, data are rarely checked for accuracy.
There are good reasons why only 1.5% of U.S. acute-care hospitals have a comprehensive EMR (Jha AK, et al. N Engl J Med 4/16/09).
Obama’s estimate of savings is an $80 billion exaggeration,” write Jerome Groopman and Pamela Hartzband (Wall Street Journal 5/12/09).
- Ongoing discussions on HIT: Health Care Renewal
- “The Syndrome of Inappropriate Overconfidence in Computing: an Invasion of Medicine by the Information Technology Industry?” by Scot M. Silverstein, M.D. J Am Phys Surg 2009;14:49-50.
- “Ministry of Information ‘Held Harmless’ by Contract,” AAPS News of the Day 4/8/09.
- “EMR: a Nonconsented Experiment,” AAPS News, July 2008.