Ezra Klein asks:
I've never read a compelling explanation of why the nation's doctors and hospitals haven't broadly adopted electronic medical records. It's not as if they're allergic to technology. At this point, cardiovascular care employs every strategy but astral projection to keep our in rhythm. It's not as if it wouldn't be cheaper and easier for them. The man hours and costs from keeping track of files, printing out labels, finding lost manila folders, and getting sued because the nurse misread the doctor's handwriting are enormous. Theoretically, insurers should be pushing on this, but they seem behind the curve, too. And it's not as if there aren't tested programs in use -- not only does Europe do electronic records well, but the VA does them beautifully, and they've released their primary program, ViSTA, as open source, for free use by anybody.
Arnold King responds:
I spent much of my career in business, and much of my focus was on use of information technology (IT). Among the lessons I learned were.
- Within a company, every business area gets the IT it deserves. Chaotic, haphazard business areas get lousy IT (and blame the IT department). Organized, well-run business areas get great IT.
- Data cannot be maintained unless there is clarity of ownership. It must be clear who is responsible for creating, maintaining, updating, and deleting the data.
Our health care system is highly fragmented. It is chaotic and haphazard, particularly when compared to a system of managed care or a government-run health care system (the latter being managed care carried to an extreme).
And Tyler Cowen joins in:
I can think of four reasons.
- Most of the benefits are reaped by the patient, and in the long run. Today's suppliers don't realize these benefits in the form of profits.
- The United States has relatively weak data protection laws. Many people don't want outsiders to know their medical history, and information compilers fear lawsuits if the information leaks out or is hacked.
- No single provider has an incentive to move first in this game. Why computerize if no one else has?
- I haven't computerized my office (is Alex laughing?), I worry more about surviving until the next day.
Overall, I think Kling is right. There is no clarity of ownership in the data. I'm not sure what potential solutions there are for this, but it is relatively easy to develop electronic records system from a technological point of view. The difficulty is in aligning the proper incentives for their implementation.
2 comments:
In the business that i am I'm not sure that there can be computerized. The nurses have to sign when they give a medication to a patient and/if/when they drop a med or misgive it. Because beleive me it happens. Anyway, that is my 2 cents worth.
I used to work for an Association based around Healthcare IT. If you had a stock (vendor, provider, etc.), you were part of our Association (annual conference had attendance over 20,000 people). So I can speak a *little* to this (I'm not a content area expert, I've only been around those who are).
At best, we are 15 - 20 years away from an EMR being "it". Having the entire healthcare industry go paperless is not as easy as every hospital just saying, "Ok, I think I'll buy some computers." Privacy and security and interoperability are massive issues. One of the biggest P&S issues is who owns the data and where is it stored. Is there a national depository created where all healthcare records are stored and all providers and patients tap into that to get and update theirs? Or, do patients keep theirs on them and provide it to the hospital when they arrive? Or do we carry our information on us in an RFID chip implanted in our skin or in a braclet or necklace? If your pharmacy, your primary care physician, your insurer, and the ER you are currently in all want your record -- who keeps it, where is it, who has the rights to update what? Then, credibility of information becomes an issue -- especially if patients have the right to alter their own EMR.
Getting all these systems to speak to each other is not as easy as plugging an iPod into an iMac. Little pockets of interoperable providers, etc. are being tried out in the forms of Regional Health Information Exchanges and also Health Information Exchanges (RHIOs and HIEs). These are trying out being interoperable and sharing records. Think testing in local, state, and regional levels before going national. Some shutdown and don't make it. Some succeed. There's lots of trial and error right now.
Patient safety and quality outcome are benefits that can be had along with financial savings. Many people die each year due to incorrect diagnosis or wrong prescriptions, etc. (scripted warning prompts of "Wait -- this guy is already on x drug, if we give him y drug, he'll blow up from the inside -- are you sure you want to prescribe this drug? click ok to continue." can actually be helpful).
There are providers out there who have gone totally paperless. I've been on three site visits (one in NY, two in TX) to see providers who were doing this and were being considered for an award around such activities (that prove to benefit the patient and the provider).
Anyway...little bit of what I've gathered. Oh, and the answer to Tyler Cowen's third point: financial gain, less (more efficient, that is) time with the patient, and improved quality of care. At least the propoganda I've read.
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