Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs
By Richard Hillestad, James Bigelow, Anthony Bower, Federico Girosi, Robin Meili, Richard Scoville and Roger Taylor
Health Affairs
September/October 2005
Abstract
To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually-by improving health care efficiency and safety-and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.
(This report is a product of the RAND HIT Project. It benefited from the guidance of an independent Steering Committee, chaired by David Lawrence, and was sponsored by Cerner, General Electric, Hewlett-Packard, Johnson and Johnson, and Xerox.)
http://content.healthaffairs.org/cgi/content/abstract/24/5/1103
And…
Hope And Hype: Predicting The Impact Of Electronic Medical Records By David U. Himmelstein and Steffie Woolhandler
Abstract
The current fascination with electronic medical records (EMRs) is not new. For decades, vendors have capitalized on this enthusiasm. But hospitals and clinics have ended up with little to show for their large outlays. Indeed, computing at a typical hospital has not gotten much beyond what was available twenty-five years ago. The RAND analysis continues the tradition of hope and hype. Unfortunately, behind their impressive predictions of savings lie a disturbing array of unproven assumptions, wishful thinking, and special effects.
http://content.healthaffairs.org/cgi/content/abstract/24/5/1121
Comment:
It is assumed to be a given that soon we are to have greater quality, greater efficiency, and a reduction in medical error through the fulfilled promise of an integrated information technology system using electronic medical records and computerized order entry systems. The
RAND article speculates on the benefits and cost savings of that Utopian concept. The Himmelstein and Woolhandler commentary explains why this is no more than a pipedream at the present. They list many of the issues that have not been resolved.
As only one example, let’s take the issue of privacy. Supporters contend that an encrypted electronic record is more secure than a paper record in a stack file. But doesn’t that record have to be accessible? Wouldn’t a system need to be in place to allow access to records of a comatose patient who is unable to give consent? If those providing immediate care would be able to gain access, then doesn’t it seem likely that others could as well. Since the goal is a nationally integrated technology system, doesn’t that mean that some patient records would require transfer through WAN rather than LAN technology, relying on the Internet? Once that record moves into a non-secure cache on the Internet, it is there forever for all the world to see. Are we really ready for that?
Who is developing this technology and for what purpose? A hint may be found in another article in this same issue of Health Affairs, reporting on use of electronic medical records in private physician offices. These offices used systems from private vendors, a process which represents another diversion of dollars from patient care to administrative intermediaries. Perhaps more alarming was the finding that the primary “benefit” of the electronic records is that they provided a means of increasing fees by upcoding, without a commensurate increase in the quality of the services provided. Is this what this technology is all about? Making more money? Private sector development and application of information technology will always hinge on the potential prospects for increasing profit.
Pete Stark has said that the technology for electronic medical records is “free” since it has already been developed and paid for by the VA system. A system developed in the public sector is designed for the simple reason to improve the care of patients. Before we could adopt a public sector system, we would need an administration that believes the government should do what it can do better.
Although the RAND HIT report is only speculative, it does threaten us with an unintended consequence (or more likely intended, considering the sponsors of the report). The political response to the concerns about escalating health care costs have been to dodge the real issues and to turn to support of information technology as the means to reduce costs by increasing efficiency. But adding an information technology system to our current fragmented system would only increase costs, and quite significantly so. Once again, we have been conned into using their rhetorical framework to debate health care reform.
Establishing efficiency is not about adding an expensive technology that wouldn’t function well under our current system. Efficiency is about reducing the profound administrative waste by adopting a single, publicly administered insurance program. Efficiency is about budgeting capital improvements to reduce the waste of excess services that result from excess capacity. Efficiency is about negotiating fair prices so that we reduce the waste of worthless or detrimental expenditures such as the marketing excesses of the pharmaceutical firms.
In spite of the challenges, we should accelerate our efforts to develop a truly beneficial information technology system. Just imagine how well an integrated information technology system would function with an integrated health care delivery system: a single payer system.