I appreciate Bob Newbell, MD, challenging the electronic health record (EHR) hype in “The Hope and the Hype of Health IT” [The Last Word, March/April 2011]. I am not a technophobe and am very familiar with the strengths and limitations of health information technology. Too many untested assumptions are driving this boondoggle, and I strongly resent being railroaded into the government EHR program. From our own membership organization, we are being pressured to “get with the program.” I have little use for that sort of advocacy.
I am sure you are familiar with family medicine's commitment to health information technology (HIT), particularly EHRs, through the Future of Family Medicine report. Released in 2004, this advocacy path predates the recent wave of federal programs to support EHR adoption and “meaningful use.” It is difficult to refute the transformational role that digital information management has had on information-rich industries outside of health care.
Since its establishment in 2003, the AAFP's Center for Health IT has worked to fulfill its mission to “promote and facilitate the adoption and optimal use of HIT by AAFP members and other office-based clinicians, for the purposes of improving the quality and safety of medical care, and increasing the efficiency of medical practice.” Our interaction with AAFP members, whether through surveys or direct contact, has confirmed the trueness of our course and the benefits derived from thoughtful preparation, appropriate selection, careful implementation and optimal use of EHRs in solo, small, medium and large ambulatory practices.
The published literature regarding EHR adoption and use, as with many topics in medicine, delivers evidence on both sides of the benefit spectrum. Though we can quote studies back and forth to support or debunk conflicting outcomes, systematic reviews may provide the most appropriate representation within this still maturing discipline. In contrast to the study by Ludwick and Doucette,1 I submit for your discernment a recent review in Health Affairs, admittedly authored by staff at the Office of the National Coordinator for Health IT, including the National Coordinator himself, which asserts that 92 percent of the recent articles on HIT reached conclusions that were positive overall.2
EHR adoption and use in a family medicine practice is not easy and is not about the potential for a $44,000 “incentive” from Medicare. It is about building an information platform from which you can optimize care for each patient you treat, increase the efficiency and satisfaction of every person you employ and, one day, be paid well for doing what you love.
I heartily agree with Bob Newbell's last sentence, “We're ready for HIT, but most HIT isn't ready for the real medical world.” The AAFP and its Center for Health IT will continue to advocate for HIT, processes and payment mechanisms that enhance the therapeutic relationship between family physicians and the patients they serve.
We still have a lot of work to do, and we hope that you will continue to help us because you have use for that sort of advocacy.