A Superficial "Take" On Electronic Health Records

Steve Lohr's June 19, 2008 New York Times opinion piece, "Most Doctors Aren't Using Electronic Health Records" cites a government report published in The New England Journal of Medicine ". . . that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care" and sadly notes that ". . . yet fewer than one in five of the nation's doctors has started using such records."

I checked the June 12 and June 19, 2008 print version of the NEJM and, noting that the article did not appear in print, concluded that the NEJM print edition uses its costly print resources more carefully than its virtual edition.

In this era of "show us the evidence" the first question Lohr should have asked is "what evidence proves that electronic health records reduce illness, reduce complications of illness, extend life and have a positive effect on outcome? The second question, with respect to the doctors' opinions, is "so what?"

Doctors' opinions reflect personal, colleagues and employers' bias. Opinions are interesting, but they are not hard evidence. Before we waste additional billions on technology which may not affect outcome positively and may affect outcome negatively, we need hard evidence. (See my blog "Clinical Competence or Electronic Medical Records" dated Sunday, May 11, 2008.)

One physician, who is implementing electronic records for a large medical group, recently told me that his job guarantees lifetime employment. Interesting observation - but how does that help patients? Another told me that he has less time for eye contact, communication and examining patients because he spends at least four minutes per visit preparing the computer record. And all of this without proof of outcome benefit.

Before we spend additional billions, buying technology which has not been proved to improve health care outcome, and before we fill the coffers of hardware and software companies and a new healthcare bureauracracy which never deals directly with patients, let's stop and ask for hard evidence of value.

The electronic health record is a tool not salvation. Before we waste additional resources, let's ask whether this technology meets the requirements of Occam's razor.