Wednesday, May 5, 2010

And the Survey Says......

As I opened Healthcare IT News today, as I do every day, I was struck by the placement of the two top stories. One article describes how EHRs are linked to higher costs and worse outcomes, and the other presents a study showing how CPOE implementation decreases death rates. If you scroll down a bit you find the almost daily story about a lost hard drive and a security breach affecting thousands of patients. To the left is the top story of the day with a photo of Secretary Sebelius granting $220 million to BEACON communities to implement HIT from Maine to Hawaii.

So what is special about this page arrangement? Nothing. For many months now, we’ve been reading study upon study of how EHRs improve health care and how EHRs destroy the doctor patient relationship and adversely affect productivity. Some practitioners are on record saying that the EHR was the best decision they ever made and others are on record reporting harm to patients. I think my old friend, Dr. Graham Chiu, said it best:
“These sorts of studies are really low value in terms of evidence. The standard is of course double blind prospective placebo controlled studies which are not possible ... so we look at pre and post implementation studies for the evidence. However, the evidence ranges from increased mortality to decreased mortality ... so we need more studies.”

The most disturbing thing though is not the flurry of contradictory studies and surveys; it is the new underlying current that tends to regard folks who bring up concerns as getting in the way of progress. This goes for patient safety advocates, privacy groups, and most of all, physicians who are concerned with their ability to meet all the deadlines while maintaining financial solvency. I’m sure some are trying to derail the administration’s effort to reform health care and that probably goes beyond just EHRs and Health IT, but the vast majority is just plain and simple,  honestly and constructively concerned. While there are no valid reasons to keep medicine bound to paper charts, there are valid reasons to be concerned with transitions of such magnitude. Computerization of Medical Records does not only need to be done; it needs to be done right, and it needs to be done right the first time around.

I’m pretty sure that we can all agree that both patient safety and privacy are paramount and that both present major risks to the success of widespread adoption of HIT. Best practices indicate that, if a project is to be successful, the larger risks ought to be tackled first. Kudos to ONC for financing the SHARP research projects targeted at resolving such problems, but those are long term efforts and we also need some immediate, maybe even temporary, resolutions. Spilled, milk cannot easily be unspilled.

As everybody should have realized by now, we are about to change how medicine is practiced in this country. It’s not about where to place the buttons on the screen and it’s not about which encryption algorithm to use. It’s about what happens to you next time you get really sick. We MUST get this one right, and time IS of essence.

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