Sunday, July 21, 2013

Electronic Medical Records Save Money! (Never Mind)

Electronic medical records (EMR) were supposed to rewire the medical grid.  It would increase efficiency, reduce redundancy, improve quality and reduce costs.  On  these measures I offer a grade of 0 for 4.  Ask any practicing doctor how EMR has impacted on his practice and be prepared for some remarks that differ from the government’s Kool Aid talking points.  EMR, thus far, hasn’t been ball bearings for the system.  More often, it gums up the works.


The EMR Maze - Enjoy!

The government spent billions of dollars with cash payments  to induce hospitals and doctors like me to jump on board the EMR express.  The Rand Corporation helped to fuel this euphoria in 2005 when it predicted exaggerated benefits of EMR.   By the way, this study was financed in part by EMR companies whom, I politely suggest, had a vested interest in the study’s conclusion.  Rand denies that they were unduly influenced by their backers, and I don’t claim that they caved on their principles.  Nevertheless, the propriety of taking money from folks whose survival may depend upon the study’s outcome is ethically problematic.  But, Rand was wrong and has publicly admitted it now.  The Rand folks are now back flipping across the countryside with new and improved pronouncements stating that EMR has added to medical costs and hasn’t delivered on its other rosy promises.

This wasn’t an epiphany.  Many folks in 2005 didn’t swallow the Rand bait.   The Whistleblower was blowing hard but apparently the frequency was above what human ears can perceive.  EMR is a money pit that has made many companies rich.  EMR systems are expensive, clumsy to use and do not communicate easily with other EMR systems.  Patients have the notion that the hundreds or more EMR systems out there can easily communicate with each other.  They can’t.  I have a few posts on EMR, and they’re not pretty.

The point here transcends the EMR mirage.  How many other promises of Obamacare will crumble in the years ahead?  Again, this won’t be a revelation.  Many of us were shouting about this on day 1.  No one could hear us above the din of health care reform.   Will these reformers, like Rand, admit that they were wrong as the evidence piles up?  Wouldn’t that be the fair and balanced thing to do? 

We’re in the Era of Medical Ridiculousness.  Call it EMR.

7 comments:

Anonymous said...

Let's see, here. You are willing to let Rand and EMR-related industries slide . . . they've seen the light and are backtracking. But Obamacare--using information gathered and funded by a previous administration--primarily a Republican-front for big technology firms--is the devil incarnate.

Scot Silverstein at the Healthcare Renewal website has done a stellar job for years, trying to expose deficiencies in healthcare IT. Have you followed his investigations? He points out that healthcare IT, poorly created and enacted, was almost guaranteed to fail. Instead of cleaning up the act of technology firms as well as their lobbyists and loopholes, it is easier to denigrate "Obamacare."

In the current form, EMRs not only fail to save money, they distance patients from providers, inundate providers with another layer of bureaucracy, and primarily serve insurance providers.

If you have time to explore Silverstein's contributions, you and fellow doctors could contribute immeasurably by influencing the direction of electronic technology. There is, IMO, promise in the field, and potential for cost-lowering. But as long as the healthcare PROVIDERS are denied a seat at the table, or who fail to speak up when sitting at the table, futuristic promises will trump needed change.

Melody

Michael Kirsch, M.D. said...

Thanks, Melody. EMR was not designed by physicians, for physicians. It is for coding, billing and to have access to records so that the government and insurance company can monitor medical 'quality'. This is the reason that very few physicians offer high praise for their EMR. At best, we tolerate it.

Anonymous said...

But Michael, by tolerating it, are you not ceding your position in the driver's seat and accepting a position at the back of the bus? When business-degree holders and actuaries are placed in charge of healthcare providers and healthcare institutions, can we hope for a good outcome?

As a practicing physician, I expect you are caught on the horns of a dilemma: do you continue practicing, using your education and training to benefit needful patients while securing a comfortable lifestyle for you and your family? or do you risk all to maintain the autonomy that you rightfully expected attached to those initials after your name?

Patients, likewise, experience a dilemma; loss of trust in physicians as well as dependence on insurance providers to maintain access to a dysfunctional system. Med. school educators--do they front for BigPharma by bringing in funding that their jobs and institutions require, or do they maintain (without PR spin) the leading role as innovative, ethical educators?

Current leadership by 'good ol' boys' intent on maintaining THEIR position in the driver's seat will not provide a good outcome for (most) doctors, patients, educators, communities.

EMR, well done, could have been--and perhaps still can be--a useful tool in the toolbox. But without transparency and ACCOUNTABILITY, I'm not holding my breath.

Melody

Anonymous said...

An unintended consequence of the electronic health record - Cleveland Clinic Journal of Medicine

http://hcrenewal.blogspot.com/2013/07/electronic-siloing-unintended.html

Melody

Michael Kirsch, M.D. said...

Hi Melody, haven't read your link yet. With regard to physicians ceding authority and the profession to others, this started decades ago and I do not think it can be recaptured. While the public is properly deeply skeptical of Obamacare and other 'reforms', it is beleaguered and saddled with so many other pressing concerns, that it is unable to grab pitchforks and demand a pullback. This is the hard truth. Elections matter. The slide of the medical profession and health care is inexorable. While there will be some bright lights for sure, there will be shadows cast everywhere. Cheer up! We don't have nationalized health care, at least not yet!

Anonymous said...

At the risk of any future jobs, my favorite "promise" of EMR was that it is paperless. Ironically, my paper pushing days have grown substantially longer due to more scanning, shredding, printing etc.
Having a system that goes down or freezes several times a day is equally frustrating.
My brief opinion only...

Edward Lincoln said...

Putting aside the political aspect...I think electronic medical are a tool that could be very useful in the right system, but people are just sort of saying "Digital! Modern! Wee!" and blowing off other, more important steps in fixing how medical records work in this country. Basically, someone just has to see it as their job to make sure the current treating physician gets all the prior medical records of a patient, and no one does. Electronic medical records would make doing that easier, but someone still has to take the time to do it...and right now no one does. My doctor had no idea if I had childhood vaccinations. A lot of folks see their pediatrician far more then they see any doctor until they reach old age, he pediatrician may know all sots of things about their health. A lot of folks in their 20s skip going to the doctor for years, and rarely do their pediatric medical records get forwarded. When my Dad retired, his medical records sat in our basement for a decade. When my Dad went to the ER, they did a barrage of (unnecessary) tests. It was very hard to get them to forward those test results to his primary care physician. Took three tries.

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