When I was a boy, I went through a period when I constantly hounded my dad for an Atari video game system like the one my best friend, Scott Florsheim, had down the road. I assumed that the reason my dad wouldn’t get me one was simply to torture me, but he claimed he had another motive. “Mitchell,” he said, “technology always leads to more problems than it solves.” My dad certainly never predicted that video games and the Internet would be a major factor in an epidemic of childhood obesity and diabetes, but he knew that this new and seemingly harmless technology was not all good. (For the record, I never got an Atari and was left to walk down the block to Scott’s house if I wanted to play Pac-Man.)
With the growing pressure in our industry to adopt electronic health records (EHRs), I keep remembering my father’s warning, and I keep wishing for more dialogue as to whether EHRs will actually better the practice of medicine. My concern is that we may have become caught up in our culture’s zeal for technology and the assumption that technology is necessarily better. A look at the evidence, however, shows that this assumption may be premature.
A 2005 systematic review of studies on information technology in medicine found surprising inconsistency in technology’s ability to lower medical error rates.1 An accompanying article on medication error rates at a hospital that had adopted a computerized physician order entry system found that, in fact, some new types of errors were being created because of this system.2 Finally, a 2006 study pointed out that a disproportionate number of studies showing benefits of EHRs come from large organizations, whose experiences may not be generalizable to smaller practices.3
On some level, we all know that while technology holds great promise, it also has its pitfalls. Consider the case of the total body CT scan. Although it seems like a reasonable idea, many of us tell our patients to be wary of this approach because there is no evidence of benefit and there is the possibility of harm if it leads to unnecessary invasive testing.
Just as the total body CT scan as a screening practice is fraught with problems, so is the blind adoption of EHRs. Perhaps a standardized EHR will allow the government or insurance companies to more easily watch over every prescription written and every lab test ordered. Or perhaps our patients will come to view us as simply technicians checking off boxes on our EHRs rather than well-trained and empathic individuals.
Don’t get me wrong. I am not a technophobe. My personal digital assistant allows me to take a library of medical information into the exam room. Using the Internet to view an X-ray or fetal heart tracing in real time at my office 30 miles away from the hospital has enormous benefits. Rapid dissemination of information from one physician to another has the potential to create a more efficient system.
However, we need to be realistic about the limits of information technology, specifically EHRs. They won’t insure more patients or make their medications less costly. They won’t make patients less likely to sue or jury awards smaller. They won’t eliminate drug-seeking behavior. They won’t stop patients from being diagnosed with the most tragic of diseases. And despite what some hope, they probably won’t fix physicians’ reimbursement problems either.
My plan is to continue investing in information technology, but I’ll proceed cautiously with my dad’s words of wisdom in mind.