Mar-Apr 2011 Table of Contents

THE LAST WORD

The Hope and the Hype of Health IT



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Diagnosing illness and treating patients: There's just not an app for that.

Fam Pract Manag. 2011 Mar-Apr;18(2):44.

There is an old saying: If all you have is a hammer, every problem looks like a nail. I find this maxim coming to mind again and again the more I read about information technology being the supposed solution to the myriad problems facing health care.

Electronic health records (EHRs) are probably the single most talked about piece of health information technology (HIT) today. EHRs have been strongly supported by various medical societies, including the AAFP, and by leading figures of both major political parties. The federal government has even earmarked billions of dollars to incentivize meaningful use of EHRs and to encourage widespread adoption. (Full disclosure: I implemented an EHR in my practice almost nine years ago.)

Although the hope is that EHRs will improve quality and reduce costs, current studies do not demonstrate this. On the issue of quality, consider these findings recently summarized in the Wall Street Journal:1

  • In an analysis of some 1.8 billion ambulatory care visits, researchers found that EHR use made no significant difference in performance on 14 of 17 quality indicators. EHRs were equated with better performance on two quality indicators and significantly worse performance on one quality indicator. Researchers concluded that EHRs “were not associated with better quality ambulatory care.”2

  • In a systematic review of 86 published papers on the use of EHRs in primary care, researchers found that “quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation.”3

  • In a study of the influence of EHRs on adherence to evidence-based guidelines for treatment of heart failure among more than 15,000 outpatients, use of EHRs was associated with improvement in the delivery of quality care on just one of seven care measures.4

  • In a systematic review of the effects of handheld EHRs on clinical care, researchers found that incorrect or redundant diagnoses occurred more often when physicians used electronic records than when they used paper records (48 instances versus 7 instances). They concluded, “This highlights another area where informatics interventions are being implemented widely without rigorous evaluation.”5

But what about cost savings? A recent study that reviewed the financial impact of digitizing medical records at approximately 4,000 hospitals “found no evidence that computerization has lowered costs or streamlined administration.”6 Could a too timid embrace of HIT account for the findings? Apparently not: “Even the select group of hospitals at the cutting edge of computerization showed neither cost nor efficiency advantages.”6

Physicians are in the business of diagnosing illness and treating patients. Practical HIT has to further that goal. The mobile drug-reference tool known as ePocrates seems to fit the bill. It enables health care providers to quickly look up medication dosages, interactions, contraindications and so forth. Unlike most HIT, it's simple, pragmatic and actually works. That's why approximately 280,000 physicians in the United States use it.7

Physicians aren't technophobes or Luddites. We're ready for HIT, but most HIT isn't ready for the real medical world.

About the Author

Dr. Newbell is a family physician in private practice in Hazel Green, Ala. Author disclosure: nothing to disclose.

Send comments to fpmedit@aafp.org.

1. Groopman J, Hartzband P. Obama's $80 billion exaggeration Wall Street Journal. March 12, 2009.

2. Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 2007;167:1400–1405.

3. Ludwick DA, Doucette J. Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics. 2009;78:22–31.

4. Walsh MN, Fonarow G, Yancy CW, et al. The influence of electronic health records on quality of care for heart failure. Circulation. 2008;118:S714.

5. Wu RC, Straus SE. Evidence for handheld electronic medical records in improving care: a systematic review. BMC Medical Informatics and Decision Making. 2006;6:26.

6. Himmelstein DU, Wright A, Woolhandler S. Hospital computing and the costs and quality of care: a national study. Am J Med. 2010;123:40–46.

7. Dolan B. Epocrates plans $75 million IPO, again. MobiHealthNews. July 9, 2010. http://mobihealthnews.com/8395/epocrates-plans-75-million-ipo-again/. Accessed Jan. 24, 2011.

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