Imagine a world where fossil fuel vehicles are gradually outlawed in favor of electric cars. The government would at first give incentives to those who purchase electric cars and then gradually replace those incentives with penalties for cars that use fossil fuel. As implausible as this appears, it is already happening with light bulbs, toilets and wind turbines. The government fancies itself as entitled to decide what works best for everyone.
A similar process is currently ongoing with health information technology (HIT). The Feds have appointed themselves as the final judge of how HIT should be used. The American Recovery and Reinvestment Act include a set of “Meaningful Use” (MU) guidelines for the use of HIT by physicians and hospitals. Beginning in 2010 the Act offered physicians financial incentives for MU compliance; by 2015 the incentives will be replaced by penalties for failure to comply with MU.
The benefits of HIT to patients and doctors appear to be obvious. The potential for improved medical record legibility, ease of access and reduction of medical errors is easy to appreciate. We all enjoy the advances that information technology has brought to our phones, cars, banks and airports. So a program meant to accelerate the adoption of HIT would seem benign enough.
But physicians who care for patients every day understand what no one else does – that the benefits of HIT are not a forgone conclusion. To us HIT has as much potential to harm patients as it has to help them. We also understand that the fund of knowledge required to safely and effectively implement HIT has not yet been adequately developed. It is therefore foolish, even dangerous, to force HIT into widespread use before it is well understood.
There is surprisingly little evidence that the electronic medical record (EMR) improves quality of care. There is in fact some evidence to suggest that EMRs currently in use, may actually reduce quality of care and raise health care costs. There are also no established EMR implementation strategies for medical practices. Implementing a complex EMR system into a busy medical practice is like replacing an aircraft’s engines while it is still flying. During implementation there can be no reduction in patient volume and no errors in patient care. Information technology is the only medical technology that has been given a “free pass,” with apparently no need to prove itself the way we prove the worthiness of new drugs, medical devices and surgical procedures.
HIT is also the only business technology in the entire economy that has been exempted from the need to show a return on investment. There is no recognized business model that makes HIT profitable, or even revenue-neutral. Like any business, a medical practice must survive financially. A practice cannot purchase and maintain HIT without a strategy to recover the investment.
Health information technology will change the practice of medicine more than any drug, imaging modality, operation or surgical device. It will profoundly affect the care of every patient. No other past or current medical advancement can make that claim.
Any new technology, including health information technology, produces unexpected adverse consequences. For adverse events in health care, government mandates create a frightening multiplier. What if the government had required all overweight patients to use Fen-Phen before its cardiac side effects were discovered? What if all patients with arthritic hips had been required to receive cobalt-containing implants? In an environment where every innovation is rightfully scrutinized before it is placed into widespread use, why do so many accept the unproven claims of HIT as unchallenged fact?
The alliance between government and the HIT industry has replaced critical analysis with blind enthusiasm and has replaced innovation with mindless regulatory compliance. What would today’s technology look like if the government had decreed back in 1984 that we had to purchase 4 MHz PCs or first generation brick-sized cell phones? They would still be “state of the art” today. Had there been government-mandated demand for these early technologies there would have been no reason to build smarter phones or faster computers.
Within the HIT industry, Meaningful Use now dominates the discussion at the expense of creativity. Achieving MU incentives has superseded original thought. Under normal business conditions, demand drives technology, not vice versa. If there were an electronic medical record that allowed physicians to provide better patient care and run their practices more efficiently, doctors would line up around the block at 4 AM to get their hands on it, just as they did for iPhones and iPads. No incentives would be necessary. Someday that will happen…but only after the government incentives are gone.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.