Obama seems to have totally hit the Kool-Aid bong about EMR’s saving the American Health Care system.
He’s not the only one, either. I recently heard some analyst yakker on PBS proclaiming in breathless tones that instituting and EMR would lead to such better health in America that it singleRAMedly would lead to all the cost savings we’re looking for in our health system. She was so spun up about it at one point I thought one of the other interviewees might suggest she get herself a room so she could give herself a little tension-release (or at least re-powder her face).
EMR’s only barely improve medical care. The overhead costs – in maintenance and updates of both software and hardware – is tremendous. They worsen charting time because they have so many boxes and forms to click and fill out on every patient. They do nothing to prevent or protect against litigation.
Their biggest utility is, so far, a theoretical one. Connectivity. If everyone in our country had their medical record in the same system, you could see a doc in Tulsa one day and Tacoma the next, and both docs could essentially function as the same care provider because they could both see the same record and continue each other’s plan.
But the idea is a myth.
This is a capitalistic country, so there’s dozens of EMR companies fighting for market share. There’s lots of venture capital involved because this is a big game with HUGE payoffs if you win it. Each EMR has some merits; NONE of them talk to each other. By none, I mean NONE. The EMR’s hate each other. They’re Mortal Kombat enemies. I’m being as genteel as possible when I describe the standoff with words like hatred, vituperation, caustic acid on mucous membranes. Get it?
Even if the EMR’s all went to counseling and became friends, the governmental obsession with medical privacy – so onerous it is now unreasonable – requires Pentagon-level encryption that nobody can afford in both time and money.
To log onto my EMR, for example, I have to enter a number from a digital keychain that refreshes itself every 3 minutes, plus my user name. I then have to enter my username and password at 2 other stages, all of which are preceeded by boot-ups, loading pages and security cross checks.
As mentioned, it turns out that charting in EMR’s takes longer than charting on paper. This means doctors will see fewer patients and spend more time charting.
Keep in mind that I’ve semi-rigorously calculated that I already spend at least 30 – 50% of my time totally avoiding patients and patient care so I can document. So, when you hear that we have a doctor shortage in this country, assume what is meant is that we actually have the right number of doctors… but because only half of their time is spent actually doctoring, we’re really about 50% short on docs.
If you look at good socialized health systems around the world, you don’t really see many EMR’s. In fact, obsession with glowing technology is what gets American medicine in trouble all the time. We already order too many high-tech tests that do nothing to increase life expectancy or quality.
The cost of our health care system isn’t a result of not having an EMR. Our costs are driven by all the extraneous junk that makes us uniquely inefficient.
Look at good health care systems, and the main thing you don’t see is entire industries piggybacking on the cash cow of medicine. Insurance companies are heavily regulated, and thus make reasonable profits. Some are government-administered and make no profit at all. Litigation is highly limited, preventing not only absurd payouts, but also preventing the much larger hidden costs to the system, which is excessive testing and charting meant to protect doctors and hospitals from dreaded litigation (the irony is, it doesn’t).
More technology is just more expense. What we need is less. Less specialization. Less litigation. Less technology. Less capitalizing on the sick among us. EMR’s are not the Jesus Christ of the American Medical system. They probably won’t help at all.
Technology won’t solve this problem, only common sense will.