The problem with electronic medical records is that the emphasis is on the "science" of medicine, including a "cookbook" approach that means we have to dot every I and cross every T to get paid. This approach means doing a "test" which also is hard science, to prove we know what we are doing.
But often the "real" problem with our patients don't get put in the chart. They are complicated psycho social things, or maybe just aches and pains. That is why it might be "cost effective" to screen them and have a lower level medical worker to see "minor" problems on paper, but unless the NP or PA sees them all the time for everything, you have a person seeing a stranger for a "cold", not Mrs. R seeing her "doc" for a cold and discussing her frustration with her marriage or drug using teenager.
The emphasis on "efficiency" means to be paid you do a test, not do old fashioned things like an examination or small talk. Yes, there are codes for small talk/counseling, but a lot of this stuff you don't put on records, because Mrs. R's sister in law works in medical records and has been known to snoop...
This emphasis on efficiency and strict protocols that will be documented by minute detail on medical records (that takes time from the time available to talk to the patient) destroys the physician patient relationship that is needed for healing, and why so many folks go to naturapaths and chiropractors who do develop a relationship with them as a doctor, not as a health care worker who sees them as a problem with a number to be processed.
It’s probably only a matter of time before hospitals go completely paperless—abandoning handwritten notes and charts in favor of electronic health records.
But will a digitized system of medical records and patient histories actually result in the cost-reducing, efficiency-increasing benefits advocates have so heartily promised?
According to a new study, the answer is no—at least for now. The research, published Monday in the journal Health Affairs, found that electronic records are unlikely to cut health care costs and may even lead doctors to order more expensive tests more often.
The study found that when using electronic records to assess a patient, doctors ordered tests at a rate 40 percent higher than those examining patients using the traditional paper records. When ordering more expensive and advanced tests such as magnetic resonance imaging (M.R.I.) or computerized tomography (CT), the rate jumped to 70 percent higher for those using electronic records.
“Our research raises real concerns about whether health information technology is going to be the answer to reducing costs,” Dr. Danny McCormick, lead author of the study and assistant professor at the Harvard Medical School, told the New York Times.
Encouraged by billions of dollars in federal spending to help physicians make the switch, hospitals across the United States have recently embarked on vigorous efforts to implement electronic health records. The change has sparked widespread debate over the drawbacks of computerized systems, bringing into question start-up costs and the changes they bring to quality of care.
Many, however, are skeptical of the most recent study’s results and remain optimistic about the potential of electronic records.
The New York Times reports:
The new study, they [health policy experts in favor of adopting electronic records] said, was also at odds with previous research. It is “one of a small minority of studies” that have doubted the value of health information technology, said Dr. David Blumenthal, a professor at the Harvard Medical School.
Dr. Blumenthal, the former national coordinator for health information technology in the Obama administration, was co-author of a study, published last year in Health Affairs, that surveyed articles in professional journals in recent years on electronic health records.
It found that 92 percent of those articles were “positive over all” about the prospect that technology would improve the efficiency and quality of care.
[via New York Times]
Photo: MC4 Army/Flickr
