Electronic Health Records: The Best is Yet to Come

There have been a number of articles published recently about the fact that savings that were predicted to flow from conversion to electronic medical records (EMR) -- sometime called electronic health records (EHR) -- have yet to be realized. Back in 2005, RAND Corporation analysts predicted, "EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT [health information technology]-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits." ["Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs," by Richard Hillestad, James Bigelow, Anthony Bower, Federico Girosi, Robin Meili, Richard Scoville and Roger Taylor, Health Affairs, 28 September 2005] As Reed Abelson and Julie Creswell report, "The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care." ["In Second Look, Few Savings From Digital Health Records," New York Times, 10 January 2013]

The "second look" referred to in the headline of Abelson's and Creswell's article was a reassessment conducted by the RAND Corporation. In an article published in Health Affairs, Dr. Arthur L. Kellermann, one of the authors of a reassessment, stated, "We've not achieved the productivity and quality benefits that are unquestionably there for the taking." The most important emotion to draw from that statement is not disappointment but hope. Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records, told Abelson and Creswell that "technology ‘‘is only a tool. Like any tool, it can be used well or poorly." The popular opinion seems to be that the tool is currently being used poorly. Dr. David J. Brailer, who worked in the Bush Administration, agrees with Blumenthal that "tens of billions of dollars could eventually be squeezed out of the health care system through the use of electronic records." He believes, however, that the Obama Administration committed a "colossal strategic error" when it it included a huge amount of money for record conversion in the stimulus package. "The vast sum of stimulus money flowing into health information technology created a 'race to adopt' mentality," he told Abelson and Creswell, "buy the systems today to get government handouts, but figure out how to make them work tomorrow.”

In the latest Health Affairs article, Kellerman and his colleague, Spencer Jones, claim there are several reasons that "electronic medical records didn’t play out as expected." ["Why electronic health records failed," by Sarah Kliff, Washington Post Wonkblog, 11 January 2013]

"To start, doctors didn't adopt electronic records as widely as expected. RAND researchers expected that about 90 percent of doctors would digitize their records, hitting levels seen in the United Kingdom and the Netherlands. But doctors have adopted at a much slower rate in the United States: Most recent research suggests about half of doctors have fully digitized their records. For hospitals, the number hovers below 30 percent. Even for the doctors that did adopt electronic records, many have run into a huge stumbling block with interoperability. The records they use at their office may not connect to a different software used at a hospital. Seventy-percent of doctors cited the lack of interoperability as a frustration with electronic records in a recent Bipartisan Policy Center survey. 'As a result, the current generation of electronic health records functions less as "ATM cards," allowing a patient or provider to access needed health information anywhere at any time, than as "frequent flier cards" intended to enforce brand loyalty to a particular health care system,” the RAND authors write."

That's a huge problem. Standardization is critical if the predicted savings are to be realized. One man that is trying to rectify that situation is a radiologist named Michael Zalis. He got so tired of "logging in and out of separate electronic health records at Massachusetts General Hospital" that he "co-founded and wrote the code for QPID, which stands for Queriable Patient Inference Dossier, a natural language search tool that extracts relevant clinical information from an EHR." ["Making Electronic Health Records More Efficient, by Zina Moukheiber, Forbes, 14 February 2013]

Moukheiber writes, "Tools that help piece together a complete portrait of patients are increasingly in demand, as clinicians try to sort out and analyze data stored in a digital health record, with the goal of delivering better care." To highlight that fact, Moukheiber reports, "QPID has grown by word of mouth, and is now deployed across Boston-based Partners HealthCare, which includes Brigham and Women’s Hospital. It is used by 5,000 clinicians in 15 departments, such as gastroenterology, anesthesia, and surgery. QPID registers an average 5 million search requests a month. ... With QPID, an anesthesiologist or a nurse at Mass General can pull in less than two minutes, says Zalis, key information, such as allergies, heart problems, and medications that could be buried in a report or a lab panel." The bottom line is that with standardization productivity and patient care both improve.

Before getting too excited and predicting that QPID is going to solve the problems currently being experienced, remember that Kellerman and Jones pointed out that some very large companies actually like the current arrangement because it "enforce(s) brand loyalty to a particular health care system." That shouldn't be too shocking since the money involved is enormous. For example, Julie Creswell reports that one of the large companies involved in EMR services, Allscripts, has more than doubled its annual revenue "from $548 million in 2009 to an estimated $1.44 billion last year." ["A Digital Shift on Health Data Swells Profits in an Industry," New York Times, 19 February 2013] According to Creswell, other large companies in the sector have seen similar increases in revenue. Clearly, those companies don't want to see those revenues fall. As a result, Creswell concludes:

"As doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors. ... Current and former industry executives say that big digital records companies like Cerner, Allscripts and Epic Systems of Verona, Wis., have reaped enormous rewards because of the legislation they pushed for. ... Executives at smaller records companies say the legislation cemented the established companies' leading positions in the field, making it difficult for others to break into the business and innovate."

If the Obama Administration is serious about making healthcare affordable, it must find a way to get the industry to agree on standards and open the door for smaller, innovative companies offering better products and services. Bill Bithoney, from Truven Health Analytics, believes that Meaningful Use (MU) incentives could be the tool to create better standards. ["Digital Health Records: Lower costs, better quality – eventually," Healthcare Blog, 22 January 2013] He writes:

"Meaningful Use I, and later MU II, should be viewed as laying the groundwork for electronic health record interventions which may ultimately result in improved health care. ... True advances in patient health outcomes, quality of care, and cost can only be achieved when electronic health records are used to share information across the entire care continuum from hospitals and nursing homes to rehab facilities to primary care physician offices. ... When most medical professionals can do things like supply discharge summary data and other pertinent medical information in electronic formats across the care continuum, we'll begin to realize health and well-being benefits of the impending healthcare digital revolution."

I'm naturally an optimist. I believe that a decent system will eventually be worked out and anticipated improvements in productivity and patient care realized along with desperately needed healthcare savings. The reason I'm optimistic is that I believe that healthcare providers will eventually force companies to make it easier to share records so that mistakes are minimized. At that point, if a company can't play nicely with others it will be asked to leave the sandbox. Clearly, it won't be easy -- but it can be done.