New York Times:
"In Second Look, Few Savings From Digital Health Records", and AMA
Med News on EHR Harms
A letter I wrote in response to the Wall Street
Journal's "A Health-Tech
Monopoly", Feb. 11, 2009 was published
Feb. 18, 2009 under the header Digitizing Medical Records May Help, but It's
Dear Wall Street Journal,
You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill.
I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants.
For £12.7 billion the
HIT (with a few exceptions) is largely a disaster. I'm far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine.
The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker.
I can only hope patients get something worthwhile for the $20 billion.
Scot Silverstein, M.D.
Faculty, Biomedical Informatics
Drexel University Institute for Healthcare Informatics
I also had penned essays on the need for a moratorium on HITECH (Nov. 2008, "Should The U.S. Call A Moratorium On Ambitious National Electronic Health Records Plans?" and Jan. 2009, "I Ask Again: Should The U.S. Call A Moratorium On Ambitious National Electronic Health Records Plans?"). My theme was that the issues with implementation of good health IT and elimination of bad health IT, and the issue of how to implement most efficiently, needed to be better understood before a national rollout. Hold off multi-billion dollar national initiatives "until we know how to get HIT right", I wrote.
Now the New York Times has this, citing a new
In Second Look, Few Savings From Digital Health Records
By REED ABELSON and JULIE CRESWELL
January 10, 2013
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.
Optimistic predictions by
“We’ve not achieved the productivity and quality benefits that are unquestionably ["unquestionably?" why?- ed.] there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by
Noted is the provenance of the 2005 report that created the windfall for the electronic records industry:
The report predicted that widespread use of electronic
records could save the
In my Feb. 2009 WSJ letter, I'd written that "it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants." It appears I was correct.
Not mentioned are harms that bad health IT is creating.
The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems. “We could be getting much more if we could take the time to do a little more planning and to set more standards,” said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system
A "little more" planning? How about several years' worth, to ensure the technologies are safe, effective and properly vetted, along with a system for post-market surveillance as exists in other healthcare sectors?
Technology “is only a tool,” said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. “Like any tool, it can be used well or poorly.” While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.
Dr. Blumenthal seems to be triangulating from his earlier 2010 NEJM statement that:
... The widespread use of electronic health records (EHRs)
Meantime, in the real world signs of my expressed concerns about a quagmire are appearing:
... Late last year, a physician practice in
A clue as to the candidness of the new report:
... The new analysis was not sponsored by any corporations,
said Dr. Kellermann, who added that some members of
Finally, this from the horse's mouth:
Dr. David J. Brailer, who was the nation’s first health information czar under President George W. Bush, said he still believed tens of billions of dollars could eventually be squeezed out of the health care system through the use of electronic records. In his view, the “colossal strategic error” that occurred was a result of the Obama administration’s incentive program.
I repeat my admonition from 2009 that I can only hope patients get something worthwhile for the $20 billion, which by now is probably many times that amount.
Finally, I note the American Medical News cites me in a Jan. 14, 2013 article as follows:
... Other experts on health IT said the
“These systems are incredibly complex,” said Scot M. Silverstein, MD, a consultant in medical informatics at
For example, he said, it would be difficult for a practicing physician to detect when data are missing from a record or that an alert failed to pop up.
Yet the title of the article is "EHR-related errors soar, but few harm patients" with a table at the bottom labeled "How rarely EHR problems harm patients." More evidence that EHRs always receive special accommodation.
I was an invited reviewer of the PA Patient Safety Authority report, and wrote about the major deficiencies of its dataset at my posts Dec. 13, 2012 post "Pennsylvania Patient Safety Authority: The Role of the Electronic Health Record in Patient Safety Events" and a follow-up Dec. 19 post "A Significant Additional Observation on the PA Patient Safety Authority Report -- Risk."
My major point was that one simply cannot know what one cannot know, when using a very incomplete dataset gathered in a setting of systematic impediments to accuracy and completeness. For instance, as I wrote in those earlier posts, through my work I personally know of cases of harms up to and including death that should have been in the PA database, but apparently are not - and I'm just one person.
We simply don't know in 2013 how many EHR errors harm patients, and the effects of increasing adoption by organizations and physicians less technology-able than current adopters. I hope the magnitude of harms is truly small, but hope is not enough; this study and report was just a 'dipping of the toes into the water' towards understanding the realities.
Incidentally, we also don't know how severely the known toxic effects of bad health IT might affect care in times of duress, e.g., an epidemic. However, I am certainly not sanguine about EHRs in their present state as robustly facilitating national emergency preparedness.
My dreaded prediction for the future? A 2016 AMA News story entitled "Known EHR-related harms soar."