This appeared a few days ago.
Why Health Care IT Is Still on Life Support
Electronic health records were supposed to save money—and lives. So far, they’ve mostly made doctors angry.
June 11, 2015
Lead image by AP Photo.
When technology “disrupts” it creates winners and losers. Hello smartphone! So long camera, encyclopedia, newspaper, book, CD, courtship, attention span. Disruption isn’t just inevitable, it’s righteous. Question tech and you’re not only a relic, you’re a job-killer and a Luddite, and possibly a Unabomber.
The information technology tsunami has hit so fast that most of us haven’t had time to think about what we might be sacrificing by trying to ride it. And that’s particularly true when it comes to the delivery of health services.
With the best of intentions, the Obama administration six years ago launched the HITECH Act, a $30 billion program to put electronic health records (EHR) in every hospital and doctors’ office. It offered incentives for docs who bought and “meaningfully used” the technology, and penalties—which start to kick in this year—for those who failed to adopt the new technology quickly enough. The goal was to get doctors to store patient data and share it electronically with the patients, other physicians, public health agencies, laboratories and other players in the vast health care enterprise that accounts for one-fifth of our economy.
There was just one problem: Medicine may have been in dire need of a high-tech revolution, but the Obama administration did not think hard enough about whether the technology was ready for medicine.
Doctors certainly seemed like a tech-friendly bunch for whom computerization would come naturally: They prescribed new drugs and prodded and inspected and sliced at us with increasingly sophisticated gadgets. But they still listened to our organs with a quaint 19th century device called the stethoscope, and wrote our prescriptions in illegible long hand. And when Obama took office, most of them still kept their patients’ records on paper, in manila folders with multi-colored tabs. Only 17 percent—the early adapters, the tech-savviest—relied on electronic health records.
Now, doctors spend many of their working hours in front of a computer screen. And they aren’t happy about it.
In principal, computerization could be a good thing. For years, the consensus of the experts was that health care lagged unconscionably behind other parts of the economy when it came to computerization and electronic records were seen as a crucial element in any plan to tame the health care monster swallowing our economy. To make health care better, cheaper and more accessible we needed to stop paying doctors for the number of things they do, and instead reimburse them for maintaining or restoring health. This could only be done when doctors, hospitals, insurers, nursing homes, psychiatric institutions—and patients themselves—got better at sharing information. And that would happen only when the data flowed electronically.
This cheery flow-chart hasn’t really materialized—not yet at least. And for that, several players—including the Obama administration—are to blame.
“The simple narrative of our age—that computers improve the performance of every industry they touch—turns out to have been magical thinking when it comes to healthcare,” writes Robert Wachter, a physician who teaches at the University of California.
According to David Brailer, the first chief of the Office of the National Coordinator for Health IT (ONC), Prime Minister Tony Blair had bragged to President George W. Bush about a since-failed British health IT initiative and Bush wanted one of his own. His vision, Bush said recently, was, “there’s a car wreck and the EMT takes a tag off the victim, plugs it into the computer and uses his records to make medical decisions.” Brother Jeb has a similarly magical view of health IT. On the campaign trail recently he pointed to his Apple watch as a potential tool in a “consumer-directed model” of health care that he would like to see replace Obamacare. “Five years from now … we’ll be able to guide our own health decisions in a way that will make us healthy … we have to get to a health system and away from a disease system.”
President Bush’s dream only started to flower when Obama started cutting big checks. His first ONC director, the patrician David Blumenthal (brother of Connecticut Senator Richard Blumenthal) had the idea of giving doctors and hospitals cash to buy electronic health records. Two other health staffers, Ezekiel Emanuel and Bob Kocher, wanted a set of “meaningful use” yardsticks to assure the incentives were properly absorbed. Obama’s transition team saw it as a unique chance to transform health care, according to Wachter in his new book, The Digital Doctor.
Lots more here:
This is a fascinating long discussion of the issues around the US use of EHRs. In Australia much is different - Australian doctors have adopted the aspects of EHRs that they have found useful and helpful - but much is the same - around external intrusion and compulsion from Government.
Do read this to see just how national systems etc. seem not to have quite done what was hoped for.
It will be time well spent.
David.
Would be interested to learn whether Uniting Healthcare/Richard Royle would spend his/their own money implementing a digital hospital (rather than governments money). time will tell i guess. Ps its always easier to spend someone else's money its another to spend your own.
ReplyDeleteDavid, I will read this reference but a few other comments.
ReplyDeleteFrancois Gremy (father of health informatics in France) provided a conference audience in the early 1990s, with the following statement. “My greatest fear is that the brilliant minds of informatics in the future will be so seduced by the technology they will forget their patients!”
In 2014 a review by the WHO of mHealth documented that few (<5) mobile health projects actually improved health care delivery.
In 2014 or early 2015 a paper from the AIHI on the use of iPads on orthopaedic ward rounds improved access to health information but the patient was left out of the communication channel!