Faith-based EMR: A formula for disaster

May 20, 2009

Lately our political system has taken on religious trappings. We are asked to have faith in our institutions, in the leaders we elected, in our values…faith that these eventually will get us back to normalcy. In the long run, I have no doubt they will. It’s the near term that worries me.

Lately our political system has taken on religious trappings. We are asked to have faith in our institutions, in the leaders we elected, in our values…faith that these eventually will get us back to normalcy. In the long run, I have no doubt they will. It's the near term that worries me. Our system of government, unfortunately, is based on hindsight rather than foresight. Leaders are thrown out after they make the mistakes that we must live with. The Obama initiative to encourage the adoption of healthcare IT is shaping up to be one of those mistakes.

Offering reimbursements to hospitals and physicians who use information technology (IT) is designed to move healthcare into the 21st century. Frontloading the program with higher payments in the early years is meant to get the process started quickly. Underlying this program, however, is the assumption that IT will make healthcare more efficient and reduce errors, an assumption based more on faith than on fact.

Despite the availability of electronic medical records systems for much of the past decade, less than 2% of acute care hospitals have a comprehensive electronic medical records system, according to a recent survey by the American Hospital Association. Only between 8% and 12% of these hospitals have even a basic EMR.

Consequently, there is not enough experience with this technology to say with certainty that the widespread adoption of EMR technology will produce the desired results. Vendors point to anecdotal evidence to support the argument that their systems are ready for prime time. But these are best case examples of what can be achieved rather than what the typical hospital or physician will experience.

The U.S. healthcare system seems headed down the same road as the U.K, whose NHS National Programme for IT to digitize medical records has been wracked by problems. A nationwide system of EMRs should now be nearing completion in the U.K., but a recent forecast by the government there indicates this will not happen for another four or five years. And this may be optimistic, say critics of the program.

The U.K. has proven that, while democracy is worthy of faith, unproven technology is not. The Obama administration's crash program to bring the medical records of thousands of hospitals and tens of thousands of physicians online could do more harm than good, introducing errors where none existed before while failing to spot the errors these systems were designed to prevent.

A phased program with beta installations designed to work out problems for different types of institutions and physicians would be a more reasoned approach than the shotgun start President Obama has put in motion. But this is all but impossible. Healthcare IT has to be implemented forcefully and quickly, as part of the Obama economic stimulus effort.

So, where do we turn? We have no choice but to depend on the Centers for Medicare and Medicaid Services to develop a truly relevant and useful definition of "meaningful use." For hospitals and physicians to be reimbursed under the Obama plan, they must demonstrate that they are using EMR systems in a meaningful way.

If CMS can tie the reimbursement of these systems to proven reductions in medical errors and increased efficiency, the goals underlying the Obama healthcare plan will be realized. The agency can do so by tying meaningful use of EMRs in their first year to the establishment of baselines for medical accuracy and productivity at hospitals and physician offices. The following years' reimbursement, then, would hinge on achieving increasingly better performance defined by fewer errors and increased productivity.

If, however, CMS bases its definition of meaningful use on increasing utilization of EMR systems, as some proponents of EMRs have suggested, it will be buying into the age-old assumption that technology by itself can solve problems. There will be no incentive to improve performance but only to use systems that may or may not have a positive effect on our healthcare system. This could harm patients, impair operation of the healthcare system, and ultimately set back the adoption of truly meaningful healthcare IT systems by years.