Tuesday, March 6, 2012

Electronic Health Records Don't Cut Costs

A new study was published in the Journal Health Affairs that reports computerized patient records are unlikely to cut health care costs and might encourage doctors to order more expensive tests.

Save your research dollars, Health Affairs...I could have told you that!

The electronic health record gives doctors information about the patient instantly and helps coordinate care between specialists who are on the same system.   Communication and patient safety are improved.  Some are built to allow the patient access to their test results and to even make on-line appointments with their doctors.  The EHR should create a more accurate record and allow complex data to be aggregated in a way that is understandable.  It should create a more efficient system but it will never lower the cost of health care and here is why.

The technology itself is very very expensive.  The cost to an individual doctor to install and maintain the EHR can be tens of thousands of dollars a year and  large health systems spend $billions converting from paper to electronic.  The promise of eliminating file clerks and paper pushers has been replaced with even more people to enter data, maintain and upgrade the system,  and act as scribes for the busy doctor.   Doctors are training now for the new specialty of  Medical Informatics and these young physicians will never treat patients...they will deal with data and maintenance of the digital record.  It is a booming and richly paid field.

Even the fasted, most facile physician spends more time with the EHR than she did with a paper chart.  The documentation is better  and more comprehensive, but it is not cheaper.  Different systems do not talk with each other and the lack of interoperability is costly.  Paper reports still need to be scanned into the EHR and that takes time and money and extra staff.

The EHR should eliminate duplicate ordering of tests when doctors can see what others have done.  But there is a culture in medicine where physicians don't "believe" the tests that another doctor or hospital ran.  Sounds crazy but it is true and it drives me crazy when I send the results with a patient and the consultant repeats the tests.   The second $2500 MRI or $600 round of blood panels is rampant in medicine...even when the doctor has the results of a test done that week.   (Tip: Patients should refuse a 2nd test if they just had it by a referring doctor) 

 There is nothing about digital records that would drive down the cost of ordering more and more expensive tests that are not needed.  That is where the cost is.   There is nothing that eliminates expensive, futile end of life care or reduces admissions to intensive care units for patients that will never leave the hospital alive. 

Technology can improve the practice of medicine.  We are too fragmented and inefficient and the EHR is an important step for patient safety.  Anyone who thinks it will lower costs is living on another planet.  There is ample proof that it is more expensive than a paper and pen.

 


6 comments:

Anonymous said...

Very provocative. I can't see how electronic records that don't communicate with each other could improve efficiency or cut costs. Until we get on one platform nationwide, we will not gain the benefits that are promised from electronic health record. We are years away from this but at least we have taken the first steps.

KM said...

There is also another part to EHR's that is not talked about much, how it changes the experience of the feeling in the exam room between a patient and doctor, making it less personal.

I had a Family Practice Doctor whose group went from paper charts to EHR's
and when so much of the talking part before and after the exam is spent looking at the laptop and typing with so much less eye contact it gives a less personal feeling. Also when a doctor is intuitive,and perceptive to what is unsaid verbally by observing and noticing facial expressions or body language there might be more going on that is perceived or picked up on than by constantly looking at a screen and avoiding eye contact when talking. Somehow it can cause a colder more impersonal exam when the typing away is only interrupted by the physical- clinical exam and an occasionally glance.

It was an interesting difference having a good relationship with the same doctor using a paper chart and EHR seeing how the experience can be changed. It seems to lessen the raport and seems like things can be missed or over looked. One example is how a stroke can show up in a droop in one side of the face or smile.

One advantage was with the tap of a key for a prescription to be sent it can be ready by the time you go to the pharmacy saving the waiting time when you are sick.

matt said...

You can only presume that this Health Affairs research is politically motivated. EHR will become an easy target for those looking to criticize government spending.

Giana Forzareli said...

I agree! What a great post! Electronic Health Records are becoming more and more of a viable way to expedite the chart process in the medical fields. EHRs promises accuracy and a more comprehensive way to read the chart. I wish that the whole field would move in this direction.

Ahmad Babas said...

Thank you for sharing this article on EHR .I have been doing research online on this subject because I have been hearing so much about it. That's how I came across your blog. I found your article very interesting and insightful. I'm going to check the site out you shared and share this blog with some of my co workers. Thank you again for sharing!

James said...

Very well said! Electronic Health Records may be quite costly, but it is for the benefit of every patient, so I guess the attempt of putting it into practice is worth it. And come to think of it, not every patient remembers his/her medical history in detail whenever the doctor asks him for it. The EHR, however, has every bit of your medical information that your doctor can study every time you consult him. He’ll then be able to give you accurate medication and appropriate pieces of advice that will result to the improvement of one’s health.

James Guertin