The Homa Files

Ken’s Take:

The evidence is equivocal, but on balance, I’m a fan of electronic med records.  As a patient, I get frustrated when I have to repeatedly document my medical history — sometimes to multiple people on the same doctor’s visit. But, I think Team Obama severely underestimates the time, effort and resources that will be required to upgrade and integrate the multitude of competing  legacy computer systems in place in hospitals, labs, and doctors’ offices.  It’ll make landing a man on the moon look like a walk in the park.

Also — while I have zero concerns re: the FBI or any other government agencies tapping my phone or rifling through my bank accounts — I do do have concerns about the lack of privacy re: medical records. 

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Excerpted from WSJ, “Obama’s $80 Billion Exaggeration”, March 11, 2009

The flagship of Pres. Obama’s healthcare proposal is the national adoption of electronic medical records — a computer-based system that would contain every patient’s clinical history, laboratory results, and treatments.

This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years, are dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true. The real-world use of electronic medical records is quite different from such an idealized vision.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly..

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

In fact, once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer — 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient’s weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called “pay for performance.”

Some have speculated that the patient data collected in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

Full article:
http://online.wsj.com/article/SB123681586452302125.html

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This entry was posted on March 16, 2009 at 8:00 am and is filed under Health Care / Medical Insurance, Obama Administration. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.