Wednesday, May 5, 2010

And the Survey Says......

As I opened Healthcare IT News today, as I do every day, I was struck by the placement of the two top stories. One article describes how EHRs are linked to higher costs and worse outcomes, and the other presents a study showing how CPOE implementation decreases death rates. If you scroll down a bit you find the almost daily story about a lost hard drive and a security breach affecting thousands of patients. To the left is the top story of the day with a photo of Secretary Sebelius granting $220 million to BEACON communities to implement HIT from Maine to Hawaii.

So what is special about this page arrangement? Nothing. For many months now, we’ve been reading study upon study of how EHRs improve health care and how EHRs destroy the doctor patient relationship and adversely affect productivity. Some practitioners are on record saying that the EHR was the best decision they ever made and others are on record reporting harm to patients. I think my old friend, Dr. Graham Chiu, said it best:
“These sorts of studies are really low value in terms of evidence. The standard is of course double blind prospective placebo controlled studies which are not possible ... so we look at pre and post implementation studies for the evidence. However, the evidence ranges from increased mortality to decreased mortality ... so we need more studies.”

The most disturbing thing though is not the flurry of contradictory studies and surveys; it is the new underlying current that tends to regard folks who bring up concerns as getting in the way of progress. This goes for patient safety advocates, privacy groups, and most of all, physicians who are concerned with their ability to meet all the deadlines while maintaining financial solvency. I’m sure some are trying to derail the administration’s effort to reform health care and that probably goes beyond just EHRs and Health IT, but the vast majority is just plain and simple,  honestly and constructively concerned. While there are no valid reasons to keep medicine bound to paper charts, there are valid reasons to be concerned with transitions of such magnitude. Computerization of Medical Records does not only need to be done; it needs to be done right, and it needs to be done right the first time around.

I’m pretty sure that we can all agree that both patient safety and privacy are paramount and that both present major risks to the success of widespread adoption of HIT. Best practices indicate that, if a project is to be successful, the larger risks ought to be tackled first. Kudos to ONC for financing the SHARP research projects targeted at resolving such problems, but those are long term efforts and we also need some immediate, maybe even temporary, resolutions. Spilled, milk cannot easily be unspilled.

As everybody should have realized by now, we are about to change how medicine is practiced in this country. It’s not about where to place the buttons on the screen and it’s not about which encryption algorithm to use. It’s about what happens to you next time you get really sick. We MUST get this one right, and time IS of essence.


  1. "It’s not about where to place the buttons on the screen and it’s not about which encryption algorithm to use. It’s about what happens to you next time you get really sick."

    It's actually the whole enchilada (pardon cinco-de-mayo pun). There is so much of healthcare that's been off track for so many years that conversations (ie. buttons) are finally being debated and surveyed.

    As with most overhaul legislation, everything gets looked at, and surveys, used for or against someone else's arguments, are what policy makers consider when making policy.

    The next time someone gets sick and has to wait hours, think of all the efficiencies (like buttons) that add up time to that wait in line.

  2. A typo in my post, "efficiencies" should read "inefficiencies".

  3. "it is the new underlying current that tends to regard folks who bring up concerns as getting in the way of progress."

    I completely agree Margalit. As you say, there are probably some saboteurs out there, but I really don't like seeing (on any issue) people knocked down for simply expressing misgivings. Constructive, informed dissent is a healthy part of debate and policy-making that should not be excluded. As the old saying goes, "Measure twice, cut once."

    I'd encourage you to read more about that CPOE study you read this morning, especially this quote by a Dr. Sharek: "Simply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety.... What provides the real opportunities for improving care is using this technology to support best practice."

  4. I was wondering what you meant, Faisal... :-)
    However, the waiting line is usually due to double and triple bookings, and those are due to the doctor needing to make a living, maybe a nice living, depending on specialty.

    As to buttons and other efficiencies, I somehow think the market can sort those out. Everybody likes to compare health care to banks, so let's do just that. I am not aware of any regulation or certification that is dictating the UI on my mobile banking, yet it's pretty slick.

    I do support HIT and what ONC is attempting to do, but maybe we are losing sight of the forest for the trees...

  5. Interesting read, Michelle. I think several folks commented to ONC about the importance of the process, more so than the actual product.
    It's true about implementation and it's very true about how you use technology. No matter how important we think we are in IT, technology in medicine is currently only a supporting tool.

    I would really like to see more physicians involved in this entire health care transformation process. Maybe a few less IT people and a few more practicing doctors.