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Stop Throwing Your Money Away on the Electronic Medical Record (or start creating value)

November 21, 2009
by James Feldbaum
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It is official. According to a Study published today in the American Journal of Medicine there have been no documented financial efficiencies from computerizing medical records even when studying the “100 banner hospitals that are most wired.”

"The idea from this administration that we're going to pay for health reform out of savings from electronic medical records is baseless propaganda," according to David U. Himmelstein, MD., associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital. "It may be politically attractive, but it's nonsense."

"Coding and other reimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical parsimony," He explained that electronic medical records have the capability of allowing billers to scan patient histories for items that might result in justifiable reimbursement. "Hospital information systems help you do this, to find every co-morbidity that helps you jack up the charges,"

On Monday, The New York Times reported on a presentation by Ashish K. Jha and Catherine M. DesRoches of Massachusetts GeneralHospital. They compared 3,000 hospitals at various stages of adoption of computerized health records, and according to the article "found little difference in the cost and quality of care" between those that had adopted and those that hadn't.

I am not surprised. I have long complained and blogged that the EMR is missing the mark. I have a hard time convincing doctors, whose engrained workflow and thoughtflow will be completely disrupted, that the pain is worth the gain. The EMR is a repository of data. We need to tap into the power of the computer to mine out information and trends that otherwise might be too subtle to reach the attention of a provider in the normal course of rounds. Studies have clearly demonstrated that there are marked differences in cost and outcome between hospitals and that expensive care does not correlate to better care. The EMR needs to address that disparity and close the quality/cost gap between institutions. Maybe then we will see some real value. We need to put meaningful effort into Clinical Decision Support and help elevate the quality of care that we deliver. Only when we bring real evidence-supported information to physicians at the point of ordering will we modify performance, safety and outcome (and maybe even cost).

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