So many people engaged in this discussion started by Matthew Holt, that I felt obliged to say something and make it sound important.
My favorite follow up is by Bob Coffield of Health Care Law Blog. Bob gets to the heart of the matter by teasing out the real issues that must be addressed, for EMRs to be really adopted by physicians en masse.
Quite a few of the comments on Matthew's blog, summarized by The Healthcare Guy, reek of frustration. Everyone offers reasons on why something cannot be done. But I would rather follow the advice of HHS Secretary Mark Leavitt, as quoted by Newt:
Anyone who claims to have the American people’s best interests in mind when tackling Medicaid reform should embrace this philosophy: the key to progress is saying “Yes, if…,” not “No, because…”
With this "YES IF" mindset, let me answer Bob's questions:
1) Do EMRs and technology allow doctors to provide better care?
YES, IF doctors commit to changing their practice patterns. No one would get any benefit from "paving a cowpath"
2) Will EMRs allow for the growth and potential benefit of evidence based medicine?
YES, IF the products are designed to do so and are easy enough to use by doctors and consumers. Evidence guidelines must be trusted.
3) Do EMRs impact patient safety?
YES, IF the EMR systems are flexible enough, not used to lock in bad processes and are kept current with data. Garbage in, garbage out.
4) Do EMRs streamline health care and make providing it more efficient?
YES, IF they are designed for ease of use and promote collaboration across the entire health care delivery chain. We have ways to go.
5) Will EMRs ultimately reduce the cost of health care even if there is a increase in costs to implement and maintain the technology?
YES, IF they are implemented in the way consistent with addressing most of the questions on this list.
6) Does better data mean better service?
YES, IF consumers can switch providers based on quality data and there are real pay-for-performance incentives to provide better service.
7) How can health insurers use data coming out EMRs to better manage costs?
THIS WAY: Design fair pay-for-performance plans, supported by the evidence coming from the population statistics out of EMR.
8) Will the data be used to negatively or positively impact the provision of care?
EITHER WAY: This is a matter of designing the right policies of who owns and controls access to data. Data itself does not do anything.
9) How will the clinical encounter data coming from EMRs be used in the claims process? Will it have a positive or negative impact.
THIS WAY: Individual claims should not be affected by the encounter data, aside from finding the right codes. But I am not so certain.
10) What are the real motivations behind federal and state politicians jumping on the EMR bandwagon?
VOTES, VOTES, VOTES. No one wants to be caught saying "No because".
11) How will we be able to get non-tech health care providers to efficiently and effectively use technology to provide better care? (If you think health care professionals are bad at using technology just visit your local law firm)
THIS WAY: Money makes the world go around. As the technology creates a pay differential they will get serious about using EMR. Technology of course must work and be easy to use.
13) Will patients even listen to good advice about preventative care, eating better and smaller portions, reducing weight, exercising more, etc. Will the data improve doctors ability to convince patients to make these lifestyle changes?
YES, IF they bear a larger cost of non-compliance instead of abidcating responsibility to employers or governments. That is why some form of consumer-directed care is necessary.
14) Will the benefits of lower utilization as a result of changing health care lifestyle ultimately benefit the consumer, employers, the doctor, the hospital or will the insurer reap the financial benefits?
YES, IF insurers are kept from monopolizing the savings through the right design of data use policies, backed by regulation.
Of course we are a long way off from satisfying these "IF" conditions. But remember, it was the president of IBM who said that "there is a world market for maybe 5 computers", back in 1948.
We will be returning for more details on these points.