In 2006 Dr. Stark wrote an article for the Annals of Internal Medicine [click here] critical of the mandate to implement the Electronic Medical Record across the board in medical practices. At the time the issue was cost. With the absorption of small practices into large health-care consortia in the last five years, the cost of implementation to the individual physician has fallen dramatically. Left is the new vexing problem: did all of this wholesale conversion to the EMR do anything to improve health care? A recent article in the Journal of Clinical Oncology suggests no. The Veterans Administration tried to improve compliance in colo-rectal cancer (CRC) screening among its patients over age 50 by modifying its EMR to nag doctors if they have not complied with recognized guidelines in CRC screening. They compared their results for those hospitals and clinics where the new software was implemented to those in which it had not yet been. The results were published in the JCO [click here] online in early October in advance of appearing in print and showed absolutely no improvement in compliance rates for CRC screening. A number of hypotheses were floated to explain why but the facts are that changing the EMR added nothing to quality of care.
A review of this subject two years ago in the Canadian Medical Association Journal showed that inserting reminders into the EMR for doctors to fix unresolved problems (e.g., abnormal lab values or cancer screening forgotten) resulted in improvements in care that ranged from zero to slight. Only the EMR implemented at the Brigham and Women’s Hospital at Harvard, with software developed in-house, resulted in a marked improvement in care. Dr. Stark’s bias is that this came about because the doctors at Harvard are smarter, but the results speak for themselves. Tweaking the EMR in most cases doesn’t do any good. Doctors are inherently resistant to being told what to do, are too busy to pay attention to outside suggestions, or are so burned out that they don’t care.
So…what happens next? Congress in its wisdom has mandated that all health-care providers who take money from the Federal Government (typically as payment for services to patients with Medicare or Medicaid) implement an EMR in their practices by 2014 or suffer a reduction in reimbursement. Given all the conflict in Congress about health care it is unlikely that anyone will investigate the wisdom of this mandate in the face of mounting evidence that the EMR does little to improve care. If you have been to the doctor recently and talked to the back of his head while his face was buried in the computer screen you will understand from a different perspective the frustration the doctor feels at having been placed in this position.