Because I write about electronic health records and interviews hospital CIOs regularly, my eyes are always drawn to stories about them in daily newspapers. In evaluating these stories, I try to cut daily newspapers some slack, because I know that they face the challenge of explaining complex technical and regulatory issues to a general audience that doesn’t usually pay attention to them. It must be difficult to maintain subtlety and nuance in a 500-word story and still grab those readers’ attention. Nevertheless, I have been dismayed over the past year to see how many articles in the New York Times seem to start with the notion that the nationwide transition to EHRs is being carried out under faulty premises or leading to negative outcomes, because the implied if unstated conclusion is that we are throwing our money away and just making things worse. Just Google “NY Times” and “electronic health records” and here are the 2012 headlines that pop up:
• “Medicare Is Faulted on Shift to Electronic Records”
• “A Shortcut to Wasted Time”
• “The Ups and Downs of Electronic Medical Records”
• “Abuse of Electronic Health Records”
• “The Cost of Electronic Medical Records”
• Medicare Bills Rise as Records Turn Electronic”
• “Do Electronic Medical Records Save Money?”
And in January 2013:
• "In Second Look, Few Savings From Digital Health Records"
This last article about a RAND study drew a response from Farzad Mostashari, M.D., national coordinator for health IT, who noted in a Jan. 16 letter to the editor that“the article misses the critical point that the key to taming health care costs is to change the way we pay for care so that we reward outcomes, value and better care coordination. All of these reforms require electronic health records to carry out.”
So I was pleasantly surprised to read the Feb. 17 "Diagnosis" column of The New York Times Magazine. Whether she meant to or not, I think the author, Lisa Sanders, M.D., made the case for building out community-wide health information exchanges that include rehabilitation hospitals, clinics and nursing homes.
Here’s the story: Doctors in Waterbury, Conn., were struggling to figure out why a 55-year-old man well on his way to recovering from a series of illnesses became confused and paranoid. After suspecting other causes, the physicians found the answer to the riddle was serotonin syndrome as a result of taking two antidepressants. The patient had gone back and forth between the hospital and a rehabilitation center, and Sanders makes the case that a breakdown in communication and an inability to share data had made the diagnosis more difficult. No one in the rehab center connected his behavioral changes with the introduction of a new serotonin-increasing drug, and no one in the emergency room knew that he had just started taking it, the article noted.
“Effectively conveying medical information is essential. Yet as patient care is shared with more providers and institutions, this basic necessity has become more difficult to manage. The electronic medical record was supposed to help,” Sanders wrote. “Waterbury Hospital uses electronic records, but the rehab facility does not. And even if it did, electronic sharing between institutions is rare.”
Making that kind of sharing less rare is the whole point of the federal regulatory process ONC has undertaken, and I think the Times just made a great case for continuing that effort. I am not suggesting that the Times should avoid criticism of the impact of EHR incentive programs, but as Dr. Mostashari points out, “even the most cynical critics don’t advocate going back to paper-based records,” which some readers may take as the implication of all these critical Times articles.