This week’s New England Journal of Medicine publishes a health policy report about electronic health records (EHRs). The article reviews the potential benefits of EHRs to patients and to physicians and laments that as of 2005 only about 23% of physicians used them.
The reasons for the slow adoption of EHRs provide an instructive illustration of deep problems in our healthcare marketplace. EHRs are expensive, but they hold the promise of allowing better patient care, fewer medical errors, and eventual cost savings. In the delivery of any other good or service a new technology that offers these benefits is adopted quickly and becomes ubiquitous. That’s why pay phones and LP records have nearly vanished; they were replaced by cell phones and CDs. Why then the stubborn persistence of paper charts? The reason is the dysfunctional way in which most healthcare is bought. The cost of the vast majority of care is paid not by patients, but by third parties, either private insurance companies or government entities. These payers also set the price that can be charged for services. Unfortunately, this applies not just for major unforeseen expenses, like catastrophic illnesses or hospitalizations, but also for routine and preventive care. The effect is that there is no financial incentive for most physicians to increase the quality of the care they deliver, just the quantity. If the price for the service is fixed, doctors can’t make more by taking better care of each patient; they can only make more by seeing more patients. So why would doctors invest the time and the capital in an EHR that provides better care? Any cost savings resulting from better health would benefit the insurance company, not the doctors. Paper charts after all, are worse for patients, but don’t slow the doctor down.
It’s only when patients pay for their own care that the competition and balance present in all other marketplaces returns to healthcare. When patients and physicians set the price, patients have a strong incentive to ensure that the care they pay for is excellent, and physicians have a strong incentive to invest in whatever technology will deliver quality care. That’s why our office had an EHR from the day we opened in 2003. While national physician groups were lobbying for government or insurance subsidies for EHR purchases, my partner and I simply bought one, confident that what was best for our patients would eventually be best for our practice.
It’s you, our patients, who make possible our EHR and our dedication to old-fashioned attentiveness powered by twenty-first century technology. Thank you.
A happy Father’s Day to all us dads!