By Steve Lohr
The New York Times, Bits blog, March 6, 2012
I wrote an article in Tuesday’s New York Times, which was based on a study published Monday in the journal Health Affairs that casts doubt on the widespread claim that computerized patient records will cut health care spending.
The study found that doctors who were able to electronically track a patient’s recent imaging tests, like X-rays and MRIs, were more likely to order new imaging tests than doctors with paper records. That is sobering news for advocates of electronic health records, whose adoption is getting a big push from federal incentive payments to physicians.
But the study is another piece of evidence, among many, in the debate surrounding electronic health records. And it’s worth keeping in mind that the debate is really about the best way to adopt the technology, and at what pace — not whether moving from paper records to the computer age makes sense.
A lot of physicians complain that the advantages of electronic health records are oversold, and that they can be complex and confusing. Yet when well designed, the technology can improve the practice of medicine.
Dr. Danny McCormick, the lead author of the study, practices at the Cambridge Health Alliance, which made the switch to a modern electronic health record system in 2005.
As Dr. McCormick said at the end of The Times article, “I’m a primary care doctor, and I would never go back.”
So what to make of the new study in Health Affairs? First, there are limitations in the data set of more than 28,000 patient visits to more than 1,100 physicians in 2008 — limitations noted in the article. And the study did not address why physicians with computer technology were more likely to order tests, though Dr. McCormick suggested that the digital technology makes it easier to order and follow-up on tests, so they do more of it.
As I noted in the article, Dr. David J. Brailer, former national coordinator for health information technology in the Bush administration, questioned the conclusions of the study because they were based on a correlation in the data rather than a controlled test.
He elaborated in a paragraph cut from the article, reasonably, for space: Still, if a controlled test reached a similar conclusion, Dr. Brailer said he would not be surprised. “An electronic health record is only part of the solution,” he said. “The real gains come from improving the quality of the information that the doctor receives, so it is more accurate, complete and timely.”
Dr. Brailer’s comment suggests a larger point. An electronic health record is a tool, one that will be used by people in response to the incentives they are given. The American health care system is predominantly fee-for-service. Doctors and hospitals are reimbursed delivering more treatment, so we get more of everything — tests, surgeries, pills.
The drive to pay health providers based more on what economists call outcomes — healthier people — instead of inputs, like tests, is under way.
The big savings in American health care, most experts agree, will come from making sure people with chronic conditions like diabetes and heart disease, manage their conditions, stay healthy and out of hospitals. My colleague Reed Abelson recently wrote an article on programs to manage the care of the 1 percent of patients who account for 25 percent of health spending — nearly $100,000 a year each.
Most of these patients are complex cases, with several chronic conditions, seeing primary care physicians and specialists, taking a series of drugs. Managing those cases efficiently is nearly impossible without the information collection, monitoring and recommendations that a modern electronic health record makes possible.
Finally, two of the four co-authors of the study in Health Affairs are co-founders of Physicians for A National Health Program, which advocates a single-payer national health care system. They are Dr. Stephanie Woolhandler, a professor at the City University of New York School of Public Health at Hunter College, and Dr. David U. Himmelstein, also a professor at the CUNY School of Public Health at Hunter College.
In an interview last weekend, Dr. Himmelstein said, “For decades, there has been this hype about how computers were going to fix everything in health care. All those predictions have been wrong. It’s vaporware.”
If technology is not the answer, that can arguably strengthen the case for other solutions, like a single-payer system.
But Dr. Himmelstein’s and Dr. Woolhandler’s views on how to pay for health care seem to have no direct effect on the study, which was analysis of national data published in a peer-reviewed journal.
Besides, the evidence worldwide suggests that electronic health records are seen as part of the long-term answer to improving care and controlling costs, according to Dr. David Blumenthal, who stepped down last year as the Obama administration’s national coordinator for health information technology.
“There is not a single-payer system in the world that is not going all out to adopt electronic health records,” said Dr. Blumenthal, a professor at Harvard Medical School.
http://bits.blogs.nytimes.com/2012/03/06/electronic-health-records-a-study-and-perspective/