Electronic Medical Records: A New Backlash

Well before electronic medical records shot onto the national agenda with President-elect Barack Obama’s pledge to spend $50 billion promoting their use, some folks were already waging a campaign against the widespread use of EMRs. At the time — and this was last April — concerns centered on privacy issues and fear that reliance on EMRs would encourage checklist-focused, cookie-cutter medicine. (I argued that many of those worries were overblown.)

Now a new backlash is building — this time from thoughtful and longtime supporters of digitized medical information who nevertheless believe that most EMR systems now in use are too expensive, bloated with unnecessary features and unable to communicate effectively with each other. In other words, they argue, the federal government might waste huge sums encouraging EMR use without improving healthcare cost or quality. In fact, the effort could just make things worse.

The heralds here are David Kibbe, a technology adviser to the American Academy of Family Physicians, and Brian Klepper, a healthcare market analyst. The two have written a series of essays, including an open letter to the Obama transition team, outlining their concerns and suggesting more measured steps that could improve patient care without saddling doctors and hospitals with cumbersome and even obsolescent IT systems:

•  In their letter to Obama’s health team, Kibbe and Klepper laid out the case against today’s EMRs, including the fact that installing them can disrupt medical practices for months. (Rick Peters, a San Diego ER doctor and technology consultant, went even further in a related essay, arguing that the healthcare-IT industry strongly resembles 1970s-era Detroit with its penchant for building cruddy, monolithic products.) Instead of dumping economic-stimulus into today’s EMR systems, Kibbe and Klepper suggested encouraging the use of lightweight, open-source, Web-based records setups that would let primary-care doctors easily share patient information with specialists (and vice versa) and give doctors a secure way to communicate with patients by email.
• In part one of a follow-up essay, Kibbe and Klepper expanded on their critique and argued that EMRs themselves aren’t likely to restrain wasteful healthcare spending without other major changes, such as eliminating the financial incentives that drive doctors to overtreat many patients.
• In part two, the duo suggested that an ideal EMR system should emphasize “decision support” – that is, by helping doctors make the best evidence-based treatment decisions possible — give patients access to their data and allow researchers to mine the aggregate (and anonymized) case histories of patients in order to study the effectiveness and safety of medical treatments.
• And today, Kibbe summarizes a new National Research Council that echoes many of his and Klepper’s arguments.

Early signs suggest Obama’s people have been listening, although it’s too soon to know exactly how the Kibbe/Klepper critique may shape upcoming federal policy.

BNET Healthcare on electronic medical records:

• Electronic Medical Records: Bad for Health?
• Health IT Honchos Advise Obama
• Why Doctors Aren’t Embracing Electronic Medical Records

Image via Flickr user briandooley, CC 2.0