Monday, November 07, 2005

Yes They Can

MedPundit says:
Count me unconvinced that computerized records will be the savior of medicine. It's just managed care in another guise
Huh. That's an interesting take, I suppose, considering the most recent Health Affairs research on electronic medical records (EMRs), which revealed astonishing benefits:
Effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits.
Medpundit is apparently aware of these benefits:
Yes, it's a more efficient method of storing and retrieving information. And yes, it's a method of reducing errors, although it also introduces new system-specific errors.
But then she proceeds to add this jewel:
The government's paramount goal in pushing a nationally-connected healthcare record is to be able to monitor and prescribe what kind of treatment everyone gets.
A little paranoid, no? If anything it's the insurance companies in doctor's and patient's faces trying to dictate care.

Take my Dad, for example. He broke a bone in his foot. His doctor prescribed a nifty little ultrasound machine that is supposed to stimulate bone growth. He took said nifty machine home with him from the doctor's office and began using it. Three weeks later he gets a letter from the insurance company that this device is not, in fact, covered. Care to take a guess for the cost of this little machine? (It's about 6 inches by 6 inches) $3,000.

No one at the doctor's office mentioned that insurance plans won't cover it. They just gave it to him, and now he owes three grand.

Really though, it's clear that MedPundit's concern here has nothing to do with the ways EMR might benefit her patients, only the way it might be a hassle for her.
One of my patients was enrolled in one for diabetes, but along the way he developed liver failure from cirrhosis. He was so malnourished from his liver disease that he no longer needed his diabetic medications and it was a total waste of time and money to order his diabetic labs. But, once a diabetic, always a diabetic, and I couldn't get him disenrolled. They kept bugging me and bugging me for his labs until I just did them. And every time I filled out their forms, I would write on the bottom - "patient severely malnourished from end-stage liver disease." It didn't matter.
Does that sound frustrating? Absolutely. Yet surely there are ways to turn off reminders, etc, if that's what you're concerned about. Or get involved in program development by giving a physician's input in ways to make HIT systems physician-friendly.

It's one thing to oppose the cost of implementing EMRs and HIT (health information technology) advances, which is why the government is leading the charge (see the VA and recent grants for practices to buy HIT software). I'd like to think things like EMRs could help patients avoid problems like my dad's (i.e. the doctor or nurse having a message pop up when they type in a treatment that this patient's insurance does NOT cover this treatment). Of course, if there's only one insurer we take out the guess work.

Medpundit's opposition to HIT exposes a selfish concern for the amount of hassle in learning a new system. I could go on about Medpundit's attitude, but I think her post should make those designing HIT think twice. If we can't come up with user-friendly systems, widespread use of EMR's will remain a fantasy. There are many, many reasons the medical community should support these technological advances. They will reduce their (or their nurse's, or other doctor's) errors, and help make their patients healthier. Don't doctor's with similar view to Medpundit complain over and over about malpractice insurance fees? EMR's offer a much better (and logical) fix than tort reform. Not to mention $81 billion a year in savings.

Reformers have decades of physician interference to learn from -- we've got to make sure system bugs and complicated interfaces don't become the focus of the AMA's next crusade.

Hat tip to Graham for the link.


At 11/07/2005 3:05 PM, Anonymous Martin said...

This brings up something I've been thinking about, in addition to EMR. It seems to me that EMR should ba a slam dunk free market effort led by the companies that already process credit-card payments. Hear me out here: The transactional privacy issues are similar (i.e. during the transaction you want no information to leak out); the payment system is already in place and most physicians' offices now seem to have credit card machines; any effective EMR system will require a way to identify and access a record, can you think of a better way than something akin to a credit card that would contain an ID number and some sort of security identifier?; payers would be able to make faster reimbursement decisions (imagine being asked to just wait ten minutes while the computer figures out if you are automatically approved for coverage or need to do something?). The big problem, that I can see, is that someone has to store the data and take responsibility for ensuring that no one breaks into it. I don't want to bet that this is a job IBM or Microsoft is willing to take on. In fact, I think the big problem with EMR is figuring out where and how to store the data so that you get the accessability benefits of an EMR without sacrificing privacy and security.

At 11/07/2005 5:54 PM, Blogger PDG said...

We use an infant-like EMR system at school now, when seeing patients, and it's frustrating as hell. The incessant clicking that seems innocuous on seeing one patient, but when you've seen over a hundred you want to just glance and the screen and be able to pick a Dx, or to have handwriting recognition software. Physicians need to be involved in the design of these programs that should be tailored by each specialty, if not to each practice. Interoperability is a big concern, because what good are records you can't send to the cardiologist, pharmacist, and the family doc?
On top of this, the initial cost is a tough activation energy to break through, even though the over all savings are more than worth it. Things are changing, but it's going to take some time before it's all EMR-ified. Family docs are actually leading the way by using the more complex systems in their offices, at least in Florida. It'll be interesting to see what it's like by the time I get out there to practice.

At 11/08/2005 7:49 AM, Anonymous Trapier K. Michael said...

Re: "Really though, it's clear that MedPundit's concern here has nothing to do with the ways EMR might benefit her patients, only the way it might be a hassle for her...

Medpundit's opposition to HIT exposes a selfish concern for the amount of hassle in learning a new system. I could go on about Medpundit's attitude, but I think her post should make those designing HIT think twice."

Easy on the character-assassination, Kate.

At 11/08/2005 1:27 PM, Blogger Kate said...

See, character assasination would have been if I made comments about her being concerned about the hassle of EMR and then proceeded to conclude that she is an incompetent doctor. But as you quoted -- "I could go on about Medpundit's attitude, but I think her post should make those designing HIT think twice." I did nothing of the sort, but used it as springboard to make a larger point, which had nothing to do with her nature as a doctor, but everything to do with how we can make it easier for people like her.

So I just don't see where your accusation is coming from. Or why you continue to ignore the larger points in my posts instead of engaging them. This one being that EMR can bring great benefits but only if we make them user-friendly, as evidenced by medpundit's post.

At 11/08/2005 2:26 PM, Anonymous Trapier K. Michael said...

You call her "selfish." That is not arguing a health policy point. That is attacking her character.

I think EHR and HIT, like all technological advances will push out the "production possibility frontier curve." [See link for definition of term]


Any point on this new production possibility frontier curve would be "weakly Pareto optimal" compared to one on the old [See link].


Thus, yes, EHR and HIT have the capacity to make life better.

That's where an economist's answer ends because she should merely state the possible effects of a policy, not advocate a policy.

A free market health policy advocate has a legitimate point that EHR and HIT, as well as Evidence-Based Medicine (EBM), are the types of initiatives one would advocate if one were seeking to put decisions in the hands of central authorities like the government, and thus take them out of the hands of healthcare consumers.

But a statist health policy advocate could certainly point out that these non-market initiatives might just be trying to accomplish the afformentioned Pareto optimality.

At 11/09/2005 7:42 AM, Blogger Ezra said...

Ah yes, the old [insert policy initiative here] is socialism in disguise argument -- now liberally dressed up in economics jargon! It's such a pity that, while the Soviet Union fell, the same arguments that were used in reference to the totalitiarian behemoth are still employed to smear Western Europe. And then the debaters run off and get the vapors when a selfish argument is diagnosed as such.

It so happens that the Bush administration, and many others, believe the only way to avoid a statist health care system is HIT. HIT will standardize and collect the data that folks require to make health care decisions, thus making HSAs, for the first time, viable. I think they're wrong, but that's a different issue. BUsiness Week, no bastion of lefty thinking, happens to agree.

Incidentally, I love the useless reference to pareto optimality and "production possibility frontier curve". The terms, for those wondering, mean "making something better for many while hurting none" and "more for less", respectively, and they really have no place in this post.

Translated back to English, the argument is "supporters think HIT will improve health care efficiency", but Trpper felt the need to liberally sprinkle with economic jargon. This is why I hate the academy. If folks want to sound smart, they should make good points. Instead, we get this parallel path to intellectual credibility that relies on impenetrably prickish lexicon deployed to dress up banal thoughts. Somebody needs to read their Orwell...

At 3/08/2010 1:34 AM, Anonymous pain management emr said...

I don't think the government wants to monitor what treatment you are getting. There are rules and regulations on what it covers and of course you have to know it,


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