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Sunday, August 30, 2009

Computers and the medical record

Many of the elected officials who I respect--President Obama, our own Idaho congressman Walt Minnick, and anybody else appropriately fired up about health care reform--say that we will all be better off when the records of our blood tests, medical procedures and office visits are made accessible by computer. It sounds simple and beautiful. Two and a half years after starting to use such computerized medical record keeping system I have a few opinions about how good it is, and what it is really good for.

In a state of unrealistic optimism, many health care reform proponents are saying that electronic medical records will, when combined with Americans adopting healthier lifestyles, save enough money to pay for health care for the presently uninsured. Healthier lifestyles are indeed a money saver, but I'm not exactly sure what transformation is supposed to happen to make us eat less crap and stop smoking.

On the other hand, though, a computerized medical record is not a cost saving device.

Having records kept in a way that is readable, easily communicated, and coordinated with things like recommendations for preventive medicine does make patients' care better. Or it would, if doctors could learn how to use it. Some health care providers take to computers like seals to the ocean, and some find that it just doesn't suit their style. Some run screaming in the other direction. When we launched our computerized medical record keeping system, everyone reduced the number of patients they would see in a day by half, and even with that everyone in my office at some point became so frustrated and hopeless that they cried. After adjusting to the system, which took a year, (yes, a year) we no longer cry, but we still can't see as many patients in a day as we could when we were scrawling notes on paper, and phoning in orders for various things. Because of the stress of adjusting to the new system, several providers left our practice, which resulted in staff cutbacks, service cutbacks, and almost made our business fail.

Now, about 2 1/2 years later, we have recovered. We know how to use our system, and it only crashes occasionally. It helps me remember what I did last time, to know what other docs did at remote locations, to review results, and my notes are always legible. If someone wants a note produced I can do that pronto, and I have instant information about drug interactions, costs and medication allergies. I can ask questions, document answers, and not have to ask the same questions again.

But it's not cheaper. Because I can document all I have done conveniently, I can bill more successfully for what I do, but it all takes time, and so I see less patients and each one costs the insurer, or the individual, more. Overhead for us is probably a bit higher, because, although we no longer have to handle paper charts, we now have to pay many 10s of thousands of dollars yearly on tech support, after the hundreds of thousands of dollars that the software and hardware cost in the first place. The software is also, still, deeply flawed.

Electronic medical records really are the wave of the future. This particular progress is unavoidable, and in the end, a positive step. But, though it is better in so many ways, it is not going to save the billions of dollars that we need to save to balance our federal budget.

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