Although the EMR is widely touted as an important part of the solution for much of what ails health care, evidence and experience suggest it ain’t so, at least in its present state of development. The AAFP post cites a recent WSJ article by Groopman and Hartzband. It opens:
Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.
That’s generous serving of Obama Kook-Aid.
The article deserves to be read in its entirety. The authors go on to review the evidence:
A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort…
A 2008 study published in Circulation, a premier cardiology journal, assessed the
influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems." Similarly, researchers from the Brigham and Women's Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, "As implemented, electronic health records were not associated with better quality ambulatory care." And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, "should be of concern to adopters, payers, and jurisdictions."
It’s worse than a gap in knowledge. It’s a complete lack of supporting evidence. Why, then, the rush for adoption?
Dr. Bobbs quotes from the Medical Economics Article:
In April 2008, a study published in the New England Journal of Medicine reported similar problems, pointing out that “Notes that are meant to be focused and selective have become voluminous and templated, distracting from the key cognitive work of providing care. Such charts may satisfy the demands of third-party payers, but they are the product of a word processor, not of physicians’ thoughtful review and analysis. They may be ‘efficient’ for the purpose of documentation but not for creative clinical thinking.”
The study also reported an example of the consequences of these problems: “A colleague at a major cancer center that recently switched to electronic medical records said that chart review during rounds has become nearly worthless. He bemoaned the vain search through meaningless repetition in multiple notes for the single line that represented a new development . . .
That came from this NEJM perspective piece by Groopman and Hartzband. I think “pimp my note" may be appropriate here to refer to electronically generated documentation that looks fancy and is long on text but devoid of substance. (In reference to the MTV show Pimp My Ride in which a car in poor condition gets a fancy make over which is mainly cosmetic, with little attention to the engine and other essentials).
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