Can Technology Cure Health Care?
Published: 2010-07-14 21:37:20By: JACOB GOLDSTEIN | Wall Street Journal | April 13, 2010
Digital medical records come with some big promises.
They'll improve patient care, in part by eliminating many errors. They'll stem the soaring growth in costs. They'll make health care more efficient.
Those are the promises, anyway. The question is, how can we make sure the technology actually delivers? How can we make sure the digitization of medical records does everything its advocates believe is possible?
The latest evidence suggests we have to search harder for the answers. A 2009 study in the American Journal of Medicine found that hospitals with more-advanced electronic systems fared no better than other hospitals on measures of administrative costs, on average, even if the systems "might modestly improve" performance on certain measures of the quality of care.
Meanwhile, many doctors and nurses say they're frustrated with the technology. While some say electronic records have improved the way they practice medicine, many others say the systems are time-consuming distractions that take away from patient care.
So, how can health-care providers get the most out of these new systems? We interviewed doctors, executives and information-technology experts who have extensive hands-on experience with electronic records and have found the best ways to make them work. Here are some of the lessons they shared.
Put Patients First
Perhaps the most important strategy has to do not with how digital records are implemented, but with how they're designed in the first place.
One common complaint: The systems seem to give short shrift to improving patient care; they focus on administrative tasks such as making savvier use of complex billing codes for insurance reimbursement. "When you're trying to read the notes of your colleague [in an electronic record], it's almost impossible to figure out what happened to the patient," says Rushika Fernandopulle, an internist, instructor at Harvard Medical School and co-founder of consultant Renaissance Health. "You have to read through two pages of all this junk that's put in to increase billing."
Dr. Fernandopulle gives an example of a note a doctor might write on a paper chart after seeing a patient with a sore throat: "Patient has a sore throat, no fever. I think this is viral pharyngitis. No need for treatment. I reassured the patient." But if a note for that visit had been generated by an electronic system designed to maximize billing, it could be pages long. "You would have to wade through an awful lot of stuff about whether they had stomach pain, diarrhea, weakness in their muscles—almost any question imaginable, most of which wouldn't be relevant to the problem at hand," Dr. Fernandopulle says.
Some doctors also complain about errors. Dr. Fernandopulle recently tried to use his electronic records system to check how many of his heart-failure patients are on a class of drugs called ace inhibitors. But several patients who he knew were taking an ace inhibitor didn't show up on the list generated by the system. It turned out that a popular pill that combines an ace inhibitor with another type of medicine wasn't recognized by the system as an ace inhibitor. So he and his staff had to go through each patient's chart to check medications.