Arnold Kling  

Computerized Medical Records

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Can politicians improve the efficiency of health care by pushing computerized medical records? I raise questions.


The bank owns the data in my checking account because my bank is involved in every transaction that changes my balance. There is no comparable actor in the health care system. My doctor is not necessarily involved in every transaction that affects my medical record...

I believe that the absence of computerized medical records largely reflects the lack of a single owner for those records. This in turn reflects a system in which there is no single owner for an individual's health care. If we change the organization of health care to provide single-point accountability, then my prediction is that computerized medical records will follow. On the other hand, if we attempt to computerize the data without changing the way that medical care is organized, then we will run into great difficulties.

For Discussion. How much incentive is needed for health care providers to supply a health care database with timely and accurate information?


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TRACKBACKS (3 to date)
TrackBack URL: http://econlog.econlib.org/mt/mt-tb.cgi/259
The author at Catallarchy in a related article titled 'Round the 'Sphere (MD Version) writes:
    My first web round-up as Dr. Trent McBride: Arnold Kling is so money and he doesn't even know it. Tyler Cowen explains how even the bureaucracy with the best of intentions is corrupted. I'd have more but I'm going to the show. [Tracked on May 19, 2005 4:54 PM]
COMMENTS (8 to date)
Randy writes:

I'm guessing that health care providers who deal with many patients per day have the same problem I do with many customers per day - the paperwork gets done last, and sometimes not at all. Large organizations with plenty of staff are great at pumping out paperwork (or database updates in this case). Smaller organizations with stressed out providers are going to go with whatever is fast and easy. If that means a couple of quick handwritten notes on a steno pad, then that's what they will do. So the incentive is a system that is fast and easy (and cheap wouldn't hurt). Let the smaller organizations help design it.

Dave Schuler writes:

Go over to Medpundit and read about the problems she's had implementing her new electronic records system. These systems are poorly designed and reduce the productivity of doctors.

Duane Gran writes:

As a person who has worked in the software development industry, I am perplexed by the EMR issue. Who is asking for EMRs? Put another way, who is the user of this technology who is clamoring for it. It sounds a solution searching for a problem. In my anecdotal discussion with people in the medical field they are content with paper records and have a workable system to share notes and to migrate records.

Erik Sargent writes:

Actually, EMRs are quite useful over time and have been shown to improve outcomes by reducing medical errors and allowing analysis that helps us move providers towards "best practices." In this case, better outcomes means both better patient health and better fiscal outcomes.

The real problem is actually quite simple. 90% of the benefits (improved outcomes) fall to the patient. 10% of the benefits fall to the insurer because of reduced cost (improved outcomes) and reduced admin costs. But, 100% of the costs fall to the provider.

This isn't to say that providers don't derive benefit, but the cost of the EMR is generally around $10K/physician to purchase, excluding training and other operating costs. That is a lot for a general practicioner in a small office. And the benefits to the provider generally come over time, not right away, so that is a big cost to overcome. There is risk that the system might not perform and there is a big hassle factor to learn the system. Plus, there is a general reluctance to change. For most providers, the results to them personally are not tangible and certain enough.

In big health systems, like Providence, Kaiser or Baylor, where the system can pay for the cost and mitigate the risk of deployment these systems thrive. Bigger systems also are able to better include the benefits to non-providers, especially if they provide hospital, office and insurance services.

We currently do data mining against our EMRs to help providers find patients who may need extra attention for conditions such as diabetes, but don't come to the office and therefore may drop out of mind. You can say this shouldn't happen, but what backstop system could you setup with a paper system? With an electronic system, we can do it with very little additional cost or hassle.

Who is asking for EMRs? - Anyone who can look at how to provide better care from a broader perspective. The total benefits are well documented and accrue to everyone involved. Its just that right now the cost, in terms of dollars, training, risk and change in general, is borne entirely by the providers instead of shared by all beneficiaries.

Lawrance George Lux writes:

EMRs forestall independent diagnosis, so forget about a Second Opinion. A Cousin who writes Software for Health Care billing will assert simplification of Health Care Cost-share would do far more good. lgl

one datapoint wrt incentivizing EMR adoption: the hawaii independant physicians assoc. was providing a $3000 cash benefit for physicians to adopt emr, but only 2 people took advantage of this.

Whitehall writes:

Isn't the patient really the "single point of responsiblity"? Frankly, I have little interest in an external organization having access and control of my medical records and history. The informational asymmetry that allows me is a commercial bargaining counterbalance to the professional information advantage of the large organization.

Robert Schwartz writes:

Clearly if the providers had any incentive to do this they would. Personally I think patients need to take the lead in this. I think I am much better served by my physicians if they have all of the information about my health. Normally, I can provide them with the information, further I have made a concious effort to have most of my care at a single hospital which has an excellent electronic record keeping system. But, one of these days I might be unconscious or other wise unable to provide information.

This web site is a first shot at a nation wide system:

http://www.medem.com/index.cfm

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