Wednesday, June 13, 2007

E-Medical Records Don't Guarantee Improved Diabetes Care

If you listen to the software industry or some politicians (including my own Senator, Hillary Rodham Clinton), the implementation of electronic medical records will remove vast amounts of waste that now sits on paper charts that are in many family doctors' filing cabinets nationwide. The claim is that those making these records electronic will miraculously enable any doctor, anywhere nationwide, to have access to a patient's full records, thus reducing errors. But the reality isn't quite as rosy as proponents would have you believe. For one thing, pushing doctors to adopt computerized medical records does nothing to guarantee this information will actually be used in treating patients, although it does eliminate medical billing and coding that adds to the time necessary to pay a claim. But beyond that, there is huge risk for data exposure, yet no legislation (including HIPAA) adequately addresses this in the same way that we have a Congressional mandate that financial record disputes must be resolved.

Other proponents of electronic medical records claim that they will produce "improved patient outcomes". That finding, apparently, is also unsubstantiated. See the following story for more complete details:

E-Medical Records No Shortcut to Good Diabetes Care
Diabetes In Control, June 12, 2007

Doctors need to use these systems as part of overall improvement plan, but the electronic medical record systems are no guarantee that diabetes patients will get better care, a new study finds.

When used in a primary-care setting, "having an electronic medical record is not sufficient for insuring the quality of diabetes care," said study author Jesse C. Crosson, from the Department of Family Medicine at UMDNJ-New Jersey Medical School. "It really isn't going to change care by itself, it has to be implemented in a context in which people are trying to improve the quality of care."

This finding, published in the May/June issue of the Annals of Family Medicine, contradicts the common wisdom on health information technology in general and about electronic medical records specifically, Crosson said. Many electronic medical record systems have been sold claiming that they will help improve quality care, he said.

To measure the impact of electronic medical record systems on the quality of care, Crosson and his colleagues collected data on the care of 927 diabetic patients in 50 doctor's offices.

They found that in offices that used electronic medical records actually offered poorer quality of care compared with those doctors who didn't use them. Patient care in the 37 offices that didn't use electric medical records was more likely to meet guidelines for treatment and intermediate outcomes compared with the 13 offices using a computerized medical record system, Crosson's group found.

These findings would apply to the care for other chronic conditions, Crosson said. "I think this is true for other conditions," he said. "I think it's more true for chronic illness care than for other conditions handled in primary care."

Crosson believes an electronic medical record system is only as good as the job it is being asked to do. "You can use a hammer to drive nails or break windows," he said.

"It really matters who's using it and what they are trying to do with it."
Electronic medical records can be effective when they are part of a system designed to improve care, Crosson said. Studies have shown that electronic records can be effective when they are used in conjunction with other efforts at improving quality, he added.

"The question is, how do we translate these findings from big institutions with lots of resources out to where most of the care is being given," Crosson said. "The technology itself won't enhance the process, but rather the people in the practice working on ways to improve quality have to ask 'how can they use this tool?'"

"Just having electronic medical records is simply not enough," added Dr. John Hsu, a physician scientist in the division of research at Kaiser Permanente in Oakland, Calif. "How you integrate it into clinical practice is critical."

Hsu noted that many of the offices had rudimentary electronic systems which are underpowered with limited information-handling abilities. "It is not a question of whether we should use electronic medical records," Hsu said. "It is a question of when and how should we use them."


Anonymous said...

There are many outstanding electronic medical record systems on the market, and many of these systems have the POTENTIAL to materially improve patient outcomes, but technology by itself cannot and will not fix everything. Transformational improvement in ambulatory quality of care requires transformational changes to the way ambulatory care physicians practice medicine. Said another way, the system needs to be fixed, and it's difficult to fix the system without a judicious application of information technology.

This is hard work, and unfortunately, the fruits of this labor are unfairly enjoyed - physicians must work hard to transform how their system is structured, and payers disproportionately reap the benefits. (That's not to say physicians don't reap any of the benefits!)

I've found that some physicians mislead themselves (or perhaps are misled by others) to believe that dramatic change is one switch flip away; that setting up an EMR system will fix everything. Many other physicians recognize such systems are one ingredient in a larger recipe for change, and some of these ingredients consist of "old fashioned" changes to how workflow is performed in the office. Of course, our payment system needs to change, too. To be sure, I've seen physicians dramatically improve their care (not to mention reduce costs and maximize time) by making the most of their software solution.

It has been my experience that the very best EMR is only as good as what the user does with it. Many systems will reinforce good care practices, and some will help physicians avoid practicing poor care, but a lot of users simply rely on the software to automate bad habits. It just so happens that ALL software systems can do this if the user wants it to. lol

Physician Advice: If a software vendor (or any type of vendor, for that matter) promises that their solution will single-handedly solve all your problems with little or no effort on your part, run in the other direction. I wish things were so simple. The right software with the right user can really make a difference, but it will not by itself solve all of your issues.

EMR Software Guy,

Anonymous said...


Scott S said...

While electronic medical records have the potential to do these things, you seem to be ignoring the fact that as the study authors note "It really isn't going to change care by itself, it has to be implemented in a context in which people are trying to improve the quality of care." There are many other things that have great potential, but unless these are implemented in the context of actually using the records to improve care, then the reality is that it may just be a costly boondoggle for software companies, but do little to actually improve care. There are a number of examples where this argument has been proven, including in countries like Ireland where electronic medical records were mandated, but the promised improvements failed to materialize. Please make a distinction between promise and actual results -- the world is littered with history of failed promises, with only a handful of success stories.

electronic medical records said...
