NDA Journal 4 Featured Article Electronic Medical Records, An Information Bubble?: EMR Claims vs. Reality by: AAPS News, March 2013 We often hear about the phenomenal exponential growth of digital technology, with the implicit assumption that the doubling will continue—unlike exponential growth phases in nature, which are part of an S-shaped curve—and that it is an unmitigated blessing. The amount of paper in a print-out of a patient’s chart and the amount of data one is required to gather also keeps doubling. It reminds me of the 1797 poem Der Zauberlehrling by Johann Wolfgang von Goethe and the Disney animation (“The Sorcerer’s Apprentice” in Fantasia). The apprentice calls up spirits to animate a broom to carry water to fill his bath, but forgets the magic word to stop it. Hacking the broom in half just doubles the deluge: “Die ich rief, die Geister, werd’ ich nun nicht los!” [“The spirits I summoned will not let me go!”] Claims vs. Reality The electronic medical record (EMR) is touted as the key to containing costs, reducing errors, improving quality, and simplifying administration: an “elegant exercise in wishful thinking,” in the words of Jerome Groopman and Pamela Hartzband. The real motive appears to be control (AAPS News, April 2011). Indeed, to spur adoption, EMRs are becoming semi-compulsory. For example, the performancein-practice (PIP) component of the Federation of State Medical Board’s Maintenance of Licensure template is EMR-dependent Also, physicians who are not “compliant” with various electronic requirements will have their Medicare fees cut. The federal government has “invested” $20 billion over the last two years in promoting health information technology (HIT), based on expectations from a 2005 RAND study of $81 billion in annual savings. The study was paid for by a group of companies that profit from selling EMR systems to hospitals and physician practices. Cerner’s revenue nearly tripled since the report was released, from $1 billion in 2005 to a projected $3 billion in 2013. The RAND study deliberately avoided looking at negative information. Double-blind, randomized studies have shown that EMRs with computerized decision-making tools did not result in a single improvement in any quality measure in the care of chronic diseases, and has not been shown to save money, writes Greg Scandlen. Some think the growth of HIT is a bubble, which is very often the result of misallocation of funds derived from government subsidies (http://tinyurl.com/adwhj5r). Costs have clearly increased. As an article in the NY Times pointed out, hospitals that received government incentives to adopt EMRs had a 47% rise in Medicare costs, compared to 32% in hospitals that did not. Scot Silverstein, M.D., of Drexel University, describes the rapid changeover to EMR as a mania. “We know it causes harm, and we don’t even know the level of magnitude.” Poorly designed software can obscure clinical data and generate incorrect treatment orders. Errors voluntarily reported to the Food and Drug Administration (FDA) probably reflect a small percentage of events that actually occur. There is a tacit admission by experts that EMRs by themselves don’t improve quality of care. You have to have an army of technical consultants in your office, writes Lawrence Huntoon, M.D., Ph.D. One study reported that it took at least nine months of EMR use and eight or more technical assistance visits to show any statistically significant improvements in key quality measures. Even after two years, physician offices without such support showed no improvement (Health IT News 1/9/13). Bad Engineering In an article entitled “Escaping the EHR Trap,” Kenneth Mandl, M.D., M.P.H, and Isaac Kohane, M.D., » But what if the current HIT bubble bursts, and better HIT helps physicians and patients take back medicine?
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