A recent RAND(1) study has concluded that the implementation of health information technology (HIT) has neither effected a reduction in the cost of healthcare nor an improvement in the quality of healthcare. The RAND authors confidently predicted that the widespread adoption of HIT will eventually achieve these goals if certain “conditions” were implemented. I do not believe that there is sufficient scientific data to support the authors’ conclusion nor validate the Federal Government’s decision to encourage the universal installation of “certified” electronic medical records (EMRs.)
As a “geek” physician who runs a solo, private practice and the creator of one of the older EMRs, I believe that I can provide a somewhat unique perspective on the HIT debate which will resonate with a large fraction of private practitioners.
Many HIT proponents justify their promotion of HIT via analogy. They posit that just as the incorporation of information technology (IT) improved the productivity and efficiencies in many industries, they contend the widespread implementation of HIT will result in many benefits to society at large. While I acknowledge that well designed HIT systems can help physicians/hospitals run their businesses more efficiently, there is no scientific evidence to conclude that this will translate into a reduction in the cost of healthcare. Further, the analogy breaks down completely vis à vis the quality of care issue.
While some have argued that the widespread use of electronic medical records will create petabytes of quantifiable data which will lead to new discoveries and a better understanding of medicine, it remains to be determined whether these discoveries will have a favorable or unfavorable impact on the cost of healthcare.
Before physicians consider prescribing a new therapy, physicians demand that the scientific community “prove” that the benefits of the therapy exceed its risks. When the therapy effects an entire population (e.g. vaccinations), the level of scientific proof must be overwhelming before the medical community recommends that the therapy is utilized by the entire society. In the case of HIT, society has assumed a great risk (e.g. great cost, disruption and restructuring of physician practice patterns and many, potential unknown “side effects”) without a priori demonstrating the putative benefits.
As a profession which is grounded in science, I think it is time that physicians mandate a pause in the Federal Government’s promotion of “certified” EMRs until there are numerous, unbiased and scientifically rigorous trials which convincingly demonstrate that the widespread use of HIT will benefit society by either improving the quality of healthcare or reducing the cost of healthcare.
References:
1. Kellerman A, Jones S, What It Will Take To Achieve The As-Yet-Unfulfilled Promises of Health Information Technology. Health Affairs 2013;32(1):63-68.
Hayward K. Zwerling, M.D., FACP, FACE is an a board-certified internal medicine physician who specializes in endocrinology. He practices at the Lowell Diabetes & Endocrine Center in North Chelmsford, MA. Zwerling is also the president of ComChart Medical Software, LLC.
