On safety and cost, electronic health records not living up to some expectations

Much of the reader response to a post I wrote last week about the government’s plan for protecting patient safety during the rollout of electronic health records has been in Ross Koppel’s camp. The University of Pennsylvania professor said that the draft plan does little to make sure the $27-billion in stimulus being used to implement the records system nationwide is furthering patient safety, not introducing more problems.

The draft plan issued last month by the Office of the National Coordinator for Health Information Technology is more of a suggestion of what vendors of the records systems, doctors, and hospitals could do—and what the agency might do in the future—than it is a dictate on what’s necessary to protect people from harms that could be caused by inaccurate medication lists, a system the loses important health information during a hospitalization, or other errors.

Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center, on his blog Monday said the plan strikes a balance, offering thoughtful guidance on patient safety while allowing the industry to continue to evolve. He writes:

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When cars were first invented, seat belts, air bags, and anti-lock brakes did not exist. Manufacturers tried to create very functional cars, learned from experience how to make them better, then innovated to create new safety technologies, many of which are now required by regulation.

Writing regulation to require seat belts depended on experience with early cars.

My grandmother was killed by a medication error caused by lack of an EHR. My mother was incapacitated by medication issues resulting from lack of health information exchange between professionals and hospitals. My wife experienced disconnected cancer care because of the lack of incentives to share information.

Halamka wrote that he’s hopeful the national plan “will appropriately accelerate the benefits” of records systems in use today while minimizing the risks of those in development.

But others balked at his concern that stricter regulation, such as the kind of testing and review required for drugs and devices, would stifle innovation. One could argue that the government should also undo regulation of pharmaceutical companies or nuclear waste producers “to stop suppressing innovation,” Dr. Reed Gelzer, a consultant and founder of Advocates for Documentation Integrity and Compliance, said in an e-mail.

“Isn’t the effect of regulation to also re-direct innovation to find better ways of improving safety (think air travel, think cars, think food) by giving the industry a... ‘floor’ level of safety requirements that innovators must compete to meet in the most efficient and effective ways possible?” he writes.

Eventually, Gelzer said, major vendors of electronic health records will have to redesign their systems to account for safety measures. That will cost a lot of money, so a delay is in those companies’ interest, he writes.

Meanwhile, Reed Abelson and Julie Creswell of the New York Times reported yesterday that a 2005 RAND Corp. report, funded by major vendors of electronic health records, overstated how much the technology could save the American health care system.

A new RAND analysis said the technology’s “disappointing performance” has not brought to fruition a projected $81 billion in yearly savings. Abelson and Creswell write:

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm’s acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.