healthy4u: healthcare IT oversell

Another Sign The EHR Experiment is Producing Undesired (But Predictable) Results: ED EHRs Produce No Efficiency Gains

Adverse results that run counter to the industry meme of healthcare IT exceptionalism are coming fast and furious.  It's hard for me to keep up with it all. In addition to my post today "EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals Suggest the True Value of Health IT Has Been Grossly Exaggerated" (<a href="http://hcrenewal.blogspot.com/2014/06/ehr-exceptionalism-debunked-care.html">http://hcrenewal.blogspot.com/2014/06/ehr-exceptionalism-debunked-care.html</a>), here's another. I won't comment on this very much: <blockquote class="tr_bq"><a href="http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting">http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting</a> May 30, 2014  Is Electronic Charting Less Efficient Than Paper Charting? Daniel J. Pallin, MD, MPH reviewing Ward MJ et al. Ann Emerg Med 2014 Jun. Operational performance was similar before and after computerization at 23 community emergency departments. The federal government has provided $17 billion in incentives to computerize healthcare. The potential benefits include improved error checking, decision support, better billing, and more data for research. However, some research has suggested that going paperless adversely affects productivity. To further examine this issue, investigators measured operational efficiency 6 months before and 6 months after implementation of an electronic health record system at 23 community emergency departments. No significant differences between the two time points were found in all efficiency factors that were measured, including time to provider, lengths of stay, walkouts, patient satisfaction, patients seen per provider per hour, and significant return visits. Citation(s): Ward MJ et al. The effect of electronic health record implementation on community emergency department operational measures of performance. Ann Emerg Med 2014 Jun; 63:723. (<a href="http://dx.doi.org/10.1016/j.annemergmed.2013.12.019">http://dx.doi.org/10.1016/j.annemergmed.2013.12.019</a>)</blockquote> One might seek to get better results for their $17 billion than, at best, parity to paper. Finally, the reader comments at that post suggest ED physicians are the ones helping foot the bill.  As one commenter put it: <blockquote class="tr_bq">"Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or discharge. So we just chart later and go home later."</blockquote> We as patients certainly should not find a development like that desirable. Note that in my work as a hospital Chief Medical Informatics Officer (CMIO) I recommended simple document imaging solutions for risk-laden ED's (where charts are usually short) to capture and make the paper chart content available anywhere/anytime ... not full-blown digital electronic medical records systems. -- SS <div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or dischage. So we just chart later and go home later. - See more at: http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting#sthash.WCiV8FQg.dpuf</div><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or dischage. So we just chart later and go home later. - See more at: http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting#sthash.WCiV8FQg.dpuf</div><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or dischage. So we just chart later and go home later. - See more at: http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting#sthash.WCiV8FQg.dpuf</div><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or dischage. So we just chart later and go home later. - See more at: http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-charting#sthash.WCiV8FQg.dpuf"</div>

Another Sign The EHR Experiment is Producing Undesired (But Predictable) Results: ED EHRs Produce No Efficiency Gains

Adverse results that run counter to the industry meme of healthcare IT exceptionalism are coming fast and furious. It's hard for me to keep up with it all.In addition to my post today "EHR Exceptiona…

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05 Jun 2014

EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals, Perhaps The Most Wired Hospitals in the World, Suggest the True Value of Information Technology in Healthcare Has Been Grossly Exaggerated

The Wall Street Journal somehow managed to get access to internal VA patient care quality data and published the following article: <blockquote class="tr_bq"> <a href="http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely-in-patient-care-1401753437">http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely-in-patient-care-1401753437</a></blockquote><blockquote>Veterans Affairs Hospitals Vary Widely in Patient Care Internal Records Show Facilities Such as Phoenix Have Far Higher Death Rates Than Peers Thomas M. Burton and Damian Paletta June 3, 2014 The Phoenix facility at the heart of the crisis at the Department of Veterans Affairs is among a number of VA hospitals that show significantly higher rates of mortality and dangerous infections than the agency's top-tier hospitals, internal records show. The criticism that precipitated last week's resignation of VA Secretary Eric Shinseki has focused largely on excessive wait times for appointments across the VA's 150-hospital medical system. But a detailed tabulation of outcomes at a dozen VA hospitals made available to The Wall Street Journal illustrates a deeper challenge: vastly disparate treatment results and what some VA doctors contend is the slippage of quality in recent years at some VA facilities. Some of the discrepancies are stark, especially for an agency known for offering high-quality care in 50 states.</blockquote> Yet, these are highly wired hospitals, perhaps the most highly wired in the world, with one EHR, VistA CPRS, allegedly among the best EHRs in the world developed over decades, and allegedly used by 100% of the clinicians. How can this be?  <blockquote class="tr_bq">... Scott McRoberts, spokesman for the Phoenix VA Health Care System, said on Monday the database "is an internal measurement system to benchmark our improvement, and is not for public consumption." The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show. ... The findings come from a nonpublic VA database called Strategic Analytics for Improvement and Learning, known as SAIL. SAIL tracks procedure outcomes and ranks VA hospitals on a scale of five stars, the best, to one star, the lowest. ... In other examples of variations in care, the Atlanta VA Medical Center, a two-star hospital for quality, has more than three times the rate of central-IV infections than the average of five-star VA hospitals. Houston's VA hospital, ranked as a two-star hospital, had a 47% higher acute-care mortality rate than the five-star hospital rate.</blockquote> A 47% higher acute-care mortality rate? Hospitals are willing to go into tens of millions of dollars of debt and knowingly endanger patients (see e.g. "In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red" at <a href="http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html">http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html</a>), and even attempt to stifle clinician conversation on drawbacks (e.g. see "Words that Work" at <a href="http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html">http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html</a>), to attain this technology on the stated reason of "improving patient safety" and "saving money." Former ONC Chair Blumenthal stated explicitly in the NEJM article "The 'Meaningful Use' Regulation for Electronic Health Records", Blumenthal and Tavenner (10.1056/NEJMp1006114, July 13, 2010): <div class="PlainText" style="font-family: arial;"> </div><blockquote dir="ltr" style="font-family: arial; margin-right: 0px;"><div class="PlainText">... EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. </div></blockquote> There is no doubt expressed there. The industry itself has convinced the Federal Government to spend tens of billions of taxpayer dollars on this technology via HITECH incentives, and to start penalizing non-adopters via Medicare cuts.  The Government has bought into the hyper-enthusiasm hook, line and sinker, when the same money might have been spent elsewhere such as on care of the underserved...or on our Veterans. Yet the data from a highly-computerized organization like the VA show that these systems cannot be all they are made out to be.  They do not automatically "improve caregivers' decisions and patients' outcomes." This is an on its face observation. They are simply a tool, and in absence of appropriate human staffing, expertise, and conducive work environment, they mean significantly "less than advertised" in terms of improving care quality and outcomes.  Finally, as the VA has gotten busier due to factors such as the return of veterans from recent wars, one must also ask if the loss of productivity, cognitive burden, and other factors caused by needing to interact with a computer rather than paper has made the computer systems more of an impediment to good care rather than a facilitating tool. I think it's time the Government start to reform the industry hype surrounding this technology with far more sober predictions that would facilitate far more cautious implementations. No "revolutions" are happening soon, at least not due to information technology in healthcare. Finally, note that EHR oversell and exceptionalism has been going on for decades.   Donald A. B. Lindberg M.D. (<a href="http://www.nlm.nih.gov/od/roster/lindberg.html">http://www.nlm.nih.gov/od/roster/lindberg.html</a>), Medical Informatics pioneer and Director of the U.S. National Library of Medicine at NIH, observed in 1969 that: <blockquote class="tr_bq"> "The [second] reason for the dearth of significant success of computers in medicine has been the flagrant and consistent "over sell" of capability on the part of manufacturers and computer enthusiasts."  </blockquote> Read his full quote by clicking on the page below, from Morris Collen's book "<a href="http://www.amazon.com/History-Medical-Informatics-United-States/dp/0964774305">A History of Medical Informatics in the United States: 1950 to 1990</a>." <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrRIuVMu4XQOTRYpbyXb2-IXrnM019VAdbzcR3D8wVVCDQtXDkhG6UlZTWtBpmUKH7s4QnIHjxuyp65kccko4iKwx6nGV3Cxu8kZ75Fss742dcTMln77zZw4tJOu25MXPfH9Oq1F-i5egc/s1600/collen168.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrRIuVMu4XQOTRYpbyXb2-IXrnM019VAdbzcR3D8wVVCDQtXDkhG6UlZTWtBpmUKH7s4QnIHjxuyp65kccko4iKwx6nGV3Cxu8kZ75Fss742dcTMln77zZw4tJOu25MXPfH9Oq1F-i5egc/s1600/collen168.jpg" width="263" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Informatics pioneer Dr. Donald Lindberg's 1969 observations on health IT oversell.  Click to enlarge.</td></tr></tbody></table> Sadly, nothing has changed in health IT, at least since the year we landed on the Moon. -- SS

The Wall Street Journal somehow managed to get access to internal VA patient care quality data and published the following article:http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely…

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05 Jun 2014