Yes They Can
Count me unconvinced that computerized records will be the savior of medicine. It's just managed care in another guiseHuh. 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.