The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.Mickey Kaus has posted emails from physicians describing their experiences with EMRs that are fascinating. This one especially:
Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.
RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.
The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.
But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.
In Second Look, Few Savings From Digital Health Records
By REED ABELSON and JULIE CRESWELL
Published: January 10, 2013
I once reviewed a hospital record from a large national medical center that I can’t name, but [you've] heard of. The patient had a major operation. The operative note was incredibly good. Page after page it recorded in exquisite detail exactly where the surgeon cut, exactly what he retracted, exactly what he saw, exactly what detailed care he took to avoid injury to this organ and that one. I was impressed. I remember thinking, “Wow. No wonder this place has a national reputation.” This was the best documented operation I had ever seen.Talk about 'always worse than you think.' Yikes.
In spite of this operation, the patient got worse. Four days later she went back for a repeat of the same operation. And the second operative note was the exactly the same as the first. Identical. Page after page, word for word, exactly the same. Leave aside the impossibility of having two multi-hour operations go exactly the same way, it is not possible to dictate or write two multi-page op notes that are word for word identical. The op notes were frauds. They were templates, worked out with the hospital risk management department to describe what should happen, and entered in the EMR with one click of a mouse. What actually happened? No one can tell.
More on Obama’s Great Health Leap Forward
We experienced a comic version of the prefab clinical observation several years ago when we took Andrew and Jimmy to the hospital for extensive speech testing, resulting in extensive reports. When we read Andrew's, we discovered that the report characterized him as 'deaf.'
Andrew is not deaf.
The rest of the report seemed to be about Andrew, not some other kid, so we assumed somebody must have hit the 'deaf' macro by mistake. That was mildly annoying, but it didn't occur to us to ask ourselves whether anything in the report was specific to Andrew.
Then there was the time C's middle school math teacher selected "Finds math difficult" from the Comment Bank....which reminds me of the then-assistant principal telling parents that teachers were no longer allowed to hand-write comments on report cards because you never knew what they'd say. (They might say something inappropriate, like "Finds math difficult.")
Meanwhile here's the latest news from the coming Disruption that is the MOOC: Crash Sinks Course on Online Teaching.
The six-week course, called "Fundamentals of Online Education: Planning and Application," was created by Fatimah Wirth, a Georgia Tech instructional designer. The emphasis of the course, which began on Jan. 28, was to teach students how to create online learning materials and manage an online class.Kaus's other post on EMRs: Obama's Great Health Leap Forward
Students were asked to sign up for groups using Google Docs, but a spokesman for Google Inc. said the program allows only 50 people to edit a document simultaneously. When the crush of students tried to sign up, the system crashed, said Debbie Morrison, who was in the class.
Ms. Wirth emailed an apology, but when things didn't improve she, in conjunction with Georgia Tech and Coursera, pulled the plug on the course.
The Ups and Downs of Electronic Medical Records
Medicare Is Faulted on Shift to Electronic Records
A Shortcut to Wasted Time
Abuse of Electronic Records
Uneasy About Online Medical Records