I haven’t made it a secret in these posts that I’m a big fan of electronic health records (EHRs). I think they improve patient care, and I think that paper medical charts will eventually go the way of the vinyl LP. (For those of you born after 1980, I’m referring to an archaic music recording medium. Yes, even more archaic than the CD.)
I’ve also written before about the very slow rate of adoption of EHRs by physicians. Well, it turns out hospitals are no better. A study in this week’s New England Journal of Medicine surveyed American hospitals for their use of EHRs. The results were underwhelming. Fewer than 2% of U.S. hospitals have electronic records in all clinical units. Another 7.6% of hospitals have EHR in some units and not in others.
The barrier most frequently cited by hospitals for EHR adoption was, not surprisingly, the same barrier physicians cited: cost. EHRs cost money, and in a marketplace which reimburses for quantity, not quality, who is going to make a major investment in better patient care? Insurance companies pay a fixed price for each service provided, whether the outcome is fantastic or marginal, whether the patient is delighted or frustrated. The financial incentive in such a market is to increase quantity as much as possible and to provide quality that is only good enough to avoid lawsuits.
Policy wonks and politicians (in both the current and previous administrations) hope to solve this problem by government subsidies for EHR adoption. An article in yesterday’s Wall Street Journal cites a Congressional Budget Office estimate that over $20 billion will be spent by the federal government on health-information technology between 2011 and 2015. EHR companies are naturally delighted as it will increase their revenue enormously. Most physicians and hospitals won’t object either, since they will be handed a valuable tool at taxpayer expense.
I think patients (not to mention taxpayers) should be more skeptical. First of all, the price of EHRs will skyrocket if they are subsidized. (See the price of healthcare after Medicare was enacted.) Second, there is little reason to believe that those who are handed a “free” EHR will use it as productively as those who invested their own resources to buy it. After all, those who see the most value in it have already voted with their dollars; those who see the least value in it will require the largest subsidy to buy in. So the cost will inevitably be greater than expected and the benefits to patients much less.
CDs replaced LPs because music fans were willing to pay a few more dollars for better music. EHRs will inevitably replace paper charts. But it will happen when patients (not insurance companies or government) are allowed to pay a little more for better care.
Wall Street Journal article: U.S. Hospitals Slow to Adopt E-Records
New England Journal of Medicine study: Use of Electronic Health Records in U.S. Hospitals
My previous post on EHRs: Only 4% of American Physicians Have Electronic Health Records