A Time Out For Health IT?

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.


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.

17 replies »

  1. Leslie, I totally agree with you. I think we just aren’t there yet, but there is SO much room for the field to grow and improve with technology. Honestly, ever since computerized tech has entered society, IT pioneers have come along and shocked the world. We just have to wait for the next one to come along for HIT.

  2. Feel free to call me. Cell: 978-407-0101. I am in the eastern time zone.

  3. I think all persons involved with HIT need to recognize that there are 2 separate, and not necessarily related, imperatives to consider when discussing HIT. First, from the view of the healthcare practitioner: Does HIT help them take care of patients and/or run a more efficient practice? The other is from the perspective of society: Does HIT improve the quality and/or reduce the cost of health care? If HIT either improves the quality or reduces the cost of health care, then a Federal incentive program to promote HIT is a rational response by the Federal Government to a dire societal problem. On the other hand, if HIT only helps the practitioner (in any way) but HIT does not have a global effect on societal healthcare, then the Federal Government should not be promoting HIT.

    Clearly it is possible to design a HIT “experiment” to answer the question “Does HIT improve the quality and/or reduce the cost of health care?” without involving the entire healthcare industry and this “experiment” could be done at a far lower cost than which is now being incurred.

    Of course, all the dollars which have been thrown at the HIT issue has now created a powerful vested interest, the HIT-PBM- health Insurance conglomeration, which has and will use it’s political muscle to promote its own interests, in the name of the “public” good. And while their proclamations to the general public and politicians might sound reasonable, their arguments cannot be refuted by a sound-bite. Thus, the complexity of the problem makes it exceedingly difficult to have a rational public discussion about the pros/cons of HIT.

  4. Reportedly Bill Gates said “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.”

    I would rather work with the VA’s CPRS than paper charts, and I like my current EMR (MD-HQ). But there is so much room for improvement…it’s heartbreaking to think of the potential we’re not accessing.

  5. I think we need to combine both yours and Dr. Zwerling’s perspectives, Adrian. I think we need to pause and reflect before we do anything else.

    From my first ever blog post years ago, which was coincidentally on this site, I have been calling on the government to solicit and listen to the voices of those who actually deliver health care. Obviously and unsurprisingly to no avail.
    I am a techie geek. I believe in technology’s ability to better almost everything it touches. But there is good IT and bad IT, and bad IT can do unspeakable harm. Where once I went as far as to write that it is the patriotic duty of every physician to adopt HIT, I can now only kick myself in the shins for ever thinking that, considering what HIT has become.

    In my increasingly fewer temperate moments when I do not engage in suicidal public writing, I can allow for the possibility that what is happening now may be OK in the long run. But we can never be sure and can never get everybody behind the cart unless we stop and measure and consider all available options.

    There is plenty of HIT out there now to allow for retrospective evaluation studies and for prospective studies of various options, such as the ones you mention. We must allocate the money and the time to do this, because frankly, I don’t think anyone is driving this bus anymore. It’s just hurtling on, driven by the original momentum and special interests coming and going. At the very least, it is extremely wasteful.

  6. Hayward, I prefer to take your post as a call for education rather than research. The research needs to be done too but right now we need to educate physicians and patients about what we can do today. We also need to support appropriate regulation to refocus a rapidly consolidating industry that’s now driven by the distorting influence of the huge federal HIT stimulus.

    I know it sounds like regulation on top of regulation but I would happily scrap all of MU3 in favor of complete and open patient and physician-directed exchange that exposes the institutional EHRs to substitutable apps and web services.


  7. Dr Zwerling says- “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.”

    I completely agree

    Dr. Rick Lippin

  8. I have a huge library of sound effects, of every description.

    I love to do either the dog barking one or the doorbell one and watch as my dogs flip out.

  9. Oh my God, Bobby….. So I clicked on the link and the monkey cries and sirens came on and my dog (the one in my avatar) ran to the window and started howling like a wolf in a full moon night… I did it again and he did it again…. my kids are having a blast….. not sure about the dog though 🙂

  10. @BobbyGee

    Speaking of clinic monkeys, that is exactly what the government solutionists have in mind, to replace doctors with lower paid and lesser educated cookbook readers and clickers and self treating doctor wannabees.

  11. @john

    There is a law called the F D and C Act, which was passed to protect the health and safety of citizens from snake oil and its sales force.

    The experiments need to be done before subjecting defenseless and downtrodden patients to unproven and untested meical devices.

  12. Interesting points that reflect a common criticism. But isn’t getting the balance between costs/benefits right the key any time we talk about technology and medicine? In my mind there’s not that much difference between a new drug and a new technology …

    Of course there are risks. That’s the way it works. The question is: are the risks worth it?

    The regulation question is more complex. The issues are incredibly thorny. What do we regulate when we don’t understand something yet? Aren’t we better off waiting until we have a clearer understanding of what’s going on? This is the way that government has been very hesitant to regulate business.

    Does this attitude sometimes benefit industry? Sometimes. On the other hand you could argue that it sometimes hurts business as much as it helps. Uncertainty hurts everybody.

    When it comes to new technologies, a case can be made that we should start regulating pretty much anything you can think of from facebook pages to playstation games to instant messaging. The problem is that actually doing something about it is really really hard.

  13. Indeed, outcomes are no better and may be worse, and costs are exorbitant. Additionally, these are medical devices that have been sold witout any vetting for safety and efficacy, in an unregulated experiment. The doctors, nurses, and patients are all guinea pigs for the vendors as they extract $ trillions from the patients and their care.