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Didn't realize it was this advanced!!!!!!!!!
Obama's $80 Billion Exaggeration
3/11/2009
Original Source: The New York Times: By Jerome Groopman and Pamela
Hartzband
Last week, President Barack Obama convened a health-care summit in
Washington to identify programs that would improve quality and restrain
burgeoning costs. He stated that all his policies would be based on
rigorous scientific evidence of benefit. The flagship proposal presented
by the president at this gathering was the national adoption of
electronic medical records -- a computer-based system that would contain
every patient's clinical history, laboratory results, and treatments.
This, he said, would save some $80 billion a year, safeguard against
medical errors, reduce malpractice lawsuits, and greatly facilitate both
preventive care and ongoing therapy of the chronically ill.
Following his announcement, we spoke with fellow physicians at the
Harvard teaching hospitals, where electronic medical records have been
in use for years. All of us were dumbfounded, wondering how such
dramatic claims of cost-saving and quality improvement could be true.
The basis for the president's proposal is a theoretical study published
in 2005 by the RAND Corporation, funded by companies including
Hewlett-Packard and Xerox that stand to financially benefit from such an
electronic system. And, as the RAND policy analysts readily admit in
their report, there was no compelling evidence at the time to support
their theoretical claims. Moreover, in the four years since the report,
considerable data have been obtained that undermine their claims. The
RAND study and the Obama proposal it spawned appear to be an elegant
exercise in wishful thinking.
To be sure, there are real benefits from electronic medical records.
Physicians and nurses can readily access all the information on their
patients from a single site. Particularly helpful are alerts in the
system that warn of potential dangers in the prescribing of a certain
drug for a patient on other therapies that could result in toxicity. But
do these benefits translate into $80 billion annually in cost-savings?
The cost-savings from avoiding medication errors are relatively small,
amounting at most to a few billion dollars yearly, as the RAND
consultants admit.
Other potential cost-savings are far from certain. The impact of
medication errors on malpractice costs is likely to be minimal, since
the vast majority of lawsuits arise not from technical mistakes like
incorrect prescriptions but from diagnostic errors, where the physician
makes a misdiagnosis and the correct therapy is delayed or never
delivered. There is no evidence that electronic medical records lower
the chances of diagnostic error.
All of us are conditioned to respect the printed word, particularly when
it appears repeatedly on a hospital computer screen, and once a
misdiagnosis enters into the electronic record, it is rapidly and
virally propagated. A study of orthopedic surgeons, comparing handheld
PDA electronic records to paper records, showed an increase in wrong and
redundant diagnoses using the computer -- 48 compared to seven in the
paper-based cohort.
But the propagation of mistakes is not restricted to misdiagnoses. Once
data are keyed in, they are rarely rechecked with respect to accuracy.
For example, entering a patient's weight incorrectly will result in a
drug dose that is too low or too high, and the computer has no way to
respond to such human error.
Throughout their report, the RAND researchers essentially ignore
downsides to electronic medical records. Rather, they base their cost
calculations on 100% compliance with the computer programs "adopted
widely and used effectively." The real-world use of electronic medical
records is quite different from such an idealized vision.
Where do the RAND policy analysts posit major cost-savings? They imagine
that the computer will guide doctors to deliver higher quality care, and
that patients will better adhere to quality recommendations embedded in
the computer programs. This would apply to both preventive interventions
like vaccines and weight reduction, and to therapy of costly chronic
maladies like diabetes and congestive heart failure. Over 15 years, the
RAND analysts assert, more than $350 billion would be saved on inpatient
care and nearly $150 billion on outpatient care. Unfortunately, data to
support such an appealing scenario are lacking.
A 2008 study published in Circulation, a premier cardiology journal,
assessed the influence of electronic medical records on the quality of
care of more than 15,000 patients with heart failure. It concluded that
"current use of electronic health records results in little improvement
in the quality of heart failure care compared with paper-based systems."
Similarly, researchers from the Brigham and Women's Hospital and Harvard
Medical School, with colleagues from Stanford University, published an
analysis in 2007 of some 1.8 billion ambulatory care visits. These
experts concluded, "As implemented, electronic health records were not
associated with better quality ambulatory care." And just this past
January, a group of Canadian researchers reviewed more than 3,700
published papers on the use of electronic medical records in primary
care delivered in seven countries. They found no solid evidence of
either benefits or drawbacks accruing to patients. This gap in
knowledge, they concluded, "should be of concern to adopters, payers,
and jurisdictions."
What is clear is that electronic medical records facilitate
documentation of services rendered by physicians and hospitals, which is
used to justify billing. Doctors in particular are burdened with
checking off scores of boxes on the computer screen to satisfy insurance
requirements, so called "pay for performance." But again, there are no
compelling data to demonstrate that such voluminous documentation
translates into better outcomes for their sick patients.
Even before these new data, there were studies casting doubt on the
benefits of electronic medical records. In response, the RAND
researchers boldly stated, "We choose to interpret reported evidence of
negative or no effect of health information technology as likely being
attributable to ineffective or not-yet-effective implementation." This
flies in the face of the scientific method, where an initial hypothesis
needs to be modified or abandoned in the face of contradictory results.
Rather than wrestle with contrary information, the report invokes the
successes of computer-based systems in saving money in industries like
banking, securities trading, and merchandizing, using ATM machines,
online brokerage and bar-coded checkouts. Medical care of human beings
-- treatment of acute and chronic illnesses and the even more complex
process of effecting lifestyle changes like smoking cessation and weight
loss to prevent disease -- is not analogous to buying bar-coded
groceries and checking-account balances online.
Some have speculated that the patient data collected by the Obama
administration in national electronic health records will be mined for
research purposes to assess the cost effectiveness of different
treatments. This analysis will then be used to dictate which drugs and
devices doctors can provide to their patients in federally funded
programs like Medicare. Private insurers often follow the lead of the
government in such payments. If this is part of the administration's
agenda, then it needs to be frankly stated as such. And Americans should
decide whether they want to participate in such a national experiment
only after learning about the nature of the analysis of their records
and who will apply the results to their health care.
All agree skyrocketing health-care costs are a dangerous weight on the
economic welfare of the nation. Much of the growing expense is due to
the proliferation of new technology and costly treatments. Significant
monies are spent for administrative overhead related to insurance
billing and payments. The burden of the uninsured who use emergency
rooms as their primary care providers, and extensive utilization of
intensive care units at the end of life, further escalate costs.
The president and his health-care team have yet to address these
difficult and pressing issues. Our culture adores technology, so it is
not surprising that the electronic medical record has been touted as the
first important step in curing the ills of our health-care system. But
it is an overly simplistic and unsubstantiated part of the solution.
We both voted for President Obama, in part because of his pragmatic
approach to problems, belief in empirical data, and openness to changing
his mind when those data contradict his initial approach to a problem.
We need the president to apply real scientific rigor to fix our
health-care system rather than rely on elegant exercises in wishful
thinking.
Drs. Groopman and Hartzband are on the staff of Beth Israel Deaconess
Medical Center in Boston and on the faculty of Harvard Medical School.
Source: http://online.wsj.com/article/SB123681586452302125.html
<http://online.wsj.com/article/SB123681586452302125.html>
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--- Begin Message ---
About Health Informatics
Health Informatics encompasses developments in the health care
industry that will help realize the President's initiative to achieve
widespread adoption of interoperable electronic health records (EHRs) in
the US within 10 years. This includes development of a National Health
Information Network based on adoption of health information standards.
Health Informatics' goal is to provide the knowledge, skills and
tools which enable medical information to be collected, managed, used
and shared efficiently. This supports SSA's mission to make the right
decision in the disability process as early as possible. Improvements in
this process will enable SSA to make significant strides towards
improving service, reducing error rates and lowering administrative
costs.
There is a wealth of information available on the Internet about
health information technology (health IT) and improvements being made in
the health care industry. Still, it is almost impossible to monitor all
of the newsletters and websites to keep current on what is going on
locally, regionally and nationally in this area.
We hope this website provides you with relevant information and
gives you a central portal to efficiently check on local, regional and
national health IT news. Since we are always interested adding
interesting and relevant content to this website, please click on the
Contact Us page to submit articles which you believe may be of value to
those at other SSA and DDS offices.
Health Informatics Defined
Health informatics is the intersection of information science
<http://en.wikipedia.org/wiki/Information_science> , medicine
<http://en.wikipedia.org/wiki/Medicine> and health care
<http://en.wikipedia.org/wiki/Health_care> . It deals with the
resources, devices and methods required to optimize the acquisition,
storage, retrieval and use of information in health and biomedicine.
Health informatics tools include not only computers but also clinical
guidelines, formal medical terminologies, and information and
communication systems.
Aspects of the field include:
* architectures for electronic medical records
<http://en.wikipedia.org/wiki/Electronic_medical_records> and other
health information systems used for billing, scheduling or research
* decision support systems
<http://en.wikipedia.org/wiki/Decision_support_system> in healthcare
* standards (e.g. DICOM <http://en.wikipedia.org/wiki/DICOM> , HL7
<http://en.wikipedia.org/wiki/HL7> ) and integration
<http://en.wikipedia.org/wiki/Data_integration> profiles (e.g.
Integrating the Healthcare Enterprise
<http://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprise> )
to facilitate the exchange of information between healthcare information
systems
<http://en.wikipedia.org/w/index.php?title=Healthcare_information_system
&action=edit> - these specifically define the means to exchange data,
not the content
* controlled <http://en.wikipedia.org/wiki/Controlled_vocabulary>
medical vocabularies (CMVs) such as the Standardized Nomenclature
<http://en.wikipedia.org/wiki/Nomenclature> of Medicine, Clinical Terms
(SNOMED <http://en.wikipedia.org/wiki/SNOMED> -CT); Logical Observation
Identifiers Names and Codes (LOINC <http://en.wikipedia.org/wiki/LOINC>
); OpenGALEN <http://en.wikipedia.org/wiki/OpenGALEN> Common Reference
Model or the highly complex UMLS <http://en.wikipedia.org/wiki/UMLS> -
used to allow a standard, accurate exchange
<http://en.wikipedia.org/w/index.php?title=Data_exchange&action=edit>
of data content between systems and providers.
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