"We will restore science to its rightful place and wield technology's wonders to raise healthcare's quality and lower its costs…"—President Barack Obama, January 20, 2009.
As you might imagine, business associates and colleagues frequently ask me what I think of our new President’s plan to inject billions of government dollars into health IT. After all, for the past several years in my role at Microsoft I’ve been traveling the world talking to government officials, healthcare executives, and clinicians about the use of information technology in the health industry. On this blog and in my keynote addresses I’ve lamented how far behind America is compared to most other developed nations in our use of electronic records in health. So, you might think that I would be elated at the idea of a multi-billion dollar government infusion of funds for health IT.
There is no question that it is well past time to move away from paper records in healthcare. But anyone who thinks that moving from paper to electronic records will solve all the ills and inequities of our healthcare system in this great land is mistaken. IT is just a tool; nothing less, nothing more. It is not by itself a solution. That’s why I applaud my colleagues who participated in producing a new report from the National Research Council (NRC) of the National Academies entitled, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. In a draft of the report released last week, the committee concludes that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even “set back the cause if these efforts continue wholly without change from their present course”.
How can that be? Many times over the course of my career I’ve observed programs from both private industry and government that give away or discount computers, PDAs, and software to clinicians. I’ve seen the computers collect dust and PDAs end up with family members because the clinicians who received them didn’t see the gains or patient care improvements promised by the donors. It also didn’t help that the physicians receiving the goods had no skin in the game. Computers and EMRs simply provide a different, and sometimes more laborious way, to document patient encounters. The value of electronic health information cannot be realized without addressing the underlying connectivity, interoperability, transparency, cognitive support, consumer engagement, appropriate incentives and new business models needed to drive adoption and truly transform the way we get and give care. The EMR is just one piece of a much larger puzzle.
The NRC report also states that “a final and significant benefit for the committee’s vision of patient-centered cognitive support is that patients themselves should be able to make use of tools designed with such support in mind. That is, entirely apart from being useful for clinicians, tools and technologies for patient-centered cognitive support should also be able to provide value for patients who wish to understand their own medical conditions more completely and thoroughly.” To that I say, Amen!
The real power of electronic records and health information comes from patients being better informed and having at their disposal tools to better manage their own health with appropriate support, guidance and intervention from medical professionals. As a society we also need to be cognizant of our limited resources, and the fact that no country can afford to “give away” as much healthcare as anyone living within its borders wants to consume. When all of this comes into alignment, only then will be able to say that health and healthcare have been transformed for the better.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
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Here's another blog based on the inadequacies of EMR's being thought of as the save all/do all when it comes to Healthcare IT.
EMR is just the beginning. IT should lead a more valuable role by "providing clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data."
The full IOM report is linked at the beginning of the blog.
I agree 100%. It's easy to say that the problem is that all doctors don't own interoperable EMRs.
An EMR that is hard to use can be worse than no EMR for both doctors and patients.
Also, other technologies can deliver more value per dollar spent, such as remote monitoring for people with chronic diseases. It's a lot cheaper to keep people out of the hospital than to take care of them when they get there.
From an economic point of view, it makes sense to spread out our bets on healthcare IT technology to systems other than EMRs. No good portfolio manager would put all of their money in one section of the stock market, so why should we bet 100% on EMRs?
Thanks for writing, Andrew. I couldn't agree more.
Bill Crounse, MD
Nice article.Thanks for sharing the information.An EMR that is hard to use can be worse than no EMR for both doctors and patients.