In his Health Affairs piece It Ain’t Necessarily So (which steals its title from my one Health Affairs article on which I was 4th banana author back in 1994) Jaan Sidorov claims that merely introducing “The Electronic Health Record” is unlikely to reduce overall system health care costs.
Stone him I say! Stone him!
Oh, hang on, I mostly agree. Although I do think that EMRs, eventually, will improve patient care quality, which he kinda doubts. But to actually reduce health care costs? Nice try RAND, CITL et al, but to do that requires limiting the amount of money put into the system. And that leads to unpleasant consequences for the main actors in the system. And as the Industry Veteran often reminds us, the whole IT thing is a side show helping us avoid that (eventual) conversation.
Actually, the truth is that Matt and I share the same taste in show tunes. However, the next time I write a manuscript, I promise to do a lit search and make sure I’m not duplicating one of Matt’s titles.
I sympathize with the frustration of many physicians who have found the promise of the EHR doesn’t measure up to the reality of what really happens in the messy trenches of day to day outpatient care. I suspect the bitterest disappointment has been among salaried employee physicians who work in large health care systems, where the details of day to day work flow make or break the EHR’s success and the docs have responsibility – and none of the authority -for making it successful.
The interesting thing is that when I talk to CIOs, they generally ‘get it.’ It’s often higher up in the chain of authority or in policy circles where the EHR is seen as an end, not a means.
The whole point of EMR is not to save money by computerizing healthcare – that is what the sales reps say. The whole point is that it gives us the opportunity for real healthcare reform through the management of cost and quality. The article makes it clear that the first step is not enough to save money, but it is “not sufficient, but necessary” for real savings. To dispute that getting healthcare on an IT platform is a little silly (IMO) – especially in this high-tech setting. I think the main gist of this article is to focus us on the real goal instead of on the means to the goal. That real goal is healthcare reform.
Finally, someone tells the truth! It is about time that someone avoids patting themselves on-the-back to either keep their sedentary research-based lifestyle going while those of us in the trenches, day-to-day, deal with the implications of our fearless business/clinical leaders who read this unfounded “research” and have to be the first to act upon it. Sorry for the rant.
I totally agree that there is value to be provided, but wouldn’t it be great to have the real conversation first, so that more money, time, human resources, thought capital, and ulcers aren’t squandered on trying to right the “unsinkable” Titanic while some stuffed shirts keep telling everyone, “Stay on-board, enjoy yourselves, she’ll never sink!”