Archive for September, 2004

The Myth of the Electronic Medical Record

Monday, September 6th, 2004

Don’t get me wrong; I believe in the electronic medical record (EMR). I wrote a column some time back arguing that the time had come when the environment, technology and strategic commitment of key actors had reached a point where health care needed to start investing in information technology and making a difference in the way care is delivered. I still believe that, and reading fellow futurist Jeff Goldsmith’s latest book Digital Medicine (a must-read, by the way) reinforced the potential for IT implementation generally, and the EMR in particular.

So why the negative title for this column? Here are three things that concern me.

Unrealistic Expectations
I have long argued that the EMR is a permanently emerging technology. It has been the future for the last 30 years and will be the future for the next 30 years. Recently the EMR has received serious attention, but I fear that the expectations for it have risen alarmingly high at the policy, strategy and practical level.

The EMR mavens of the left and right in Washington violently agree that a digital future will save lives, save money and make us all happy. I hope this is true, but I suspect they are betting too much on what the technology can deliver, at least in the short run. More experienced hands are questioning the true pay-off of an EMR even though they are making the investments. As one seasoned hospital CEO put it to me recently, “I am spending $60 million on the EMR. When all is said and done, I will improve quality but I won’t save money. It will cost more.”

The EMR needs to be implemented to improve safety, provide a better operating platform for the future, and help create a digital culture for the organization, but it is not the panacea that some in Washington might think.

The Power of Registries
In a whole series of meetings I have had over the last few months, from Canada to the Carolinas, I have become acutely aware of the power of simple disease registries, particularly for diabetic patients. Since by most estimates 70 percent of health care costs are for chronic diseases, one would think that we would all be focused on managing these patients. Unfortunately, the structure of the delivery system, nor the reimbursement system, nor the all-singing, all-dancing hospital-based EMR does much to support the management of chronically ill patients.

What seems to work well is a simple registry of patients, with a system of clinical follow-up. I have heard people talk about how they have accomplished this effectively with sophisticated digital registries, but I also have heard people who did it on an Excel spreadsheet, or 3-by-5 cards, or even graph paper (seriously), and realize almost the same results. The key is to follow up on patients and engage them in their care. We need to learn this lesson: You don’t need to spend $60 million to make a positive difference in health care delivery using information technology.

Stick to It
The hardest challenge of all is to stick to the task of implementation. As Kaiser has so ably demonstrated, vision and financial commitment are not enough to overcome the profound barriers of implementation in a large organization. While I am confident that Kaiser will succeed in its multibillion-dollar investment in a standardized EMR, I was similarly confident when it committed to a different solution five years ago. We need organizations like Kaiser to stick to the task, implement successfully and show the rest of us that it can and should be done.

Ian Morrison is an author, consultant and futurist. He is also a regular contributor to H&HN OnLine.