All Quiet on the Western Front?

You'd think with all the hubbub around transparency and EMRs that I'd be writing like a man possessed these days. While it's true that I've rarely been busier, I'm mostly sitting, watching, waiting. Something big is about to happen, that's for sure.


Stimulus money is already being spent, agencies are fervently plannign on where best to put the money once it starts flowing. I've been part of some very interesting discussions, and I've gotten to hear about som every interesting plans. I've also been part of some very odd discussions, with the requisite odder plans.

Myself, I'm working on several health care transparency projects right now, plus a P4P project which is extremely interesting, so I'm keeping busy for sure, but I am on tenterhooks, drooling with the thought of all the data that might start becoming available if any of this health reform movement actually gets it's steam up.

The problem is, you can't really mix health reform, which by definition means trying to attain lower costs, with stimulus spending, which by definition means spending like there's no tomorrow.

With the proposition that moeny will fall from the sky for physicians to buy EMR software, lots of companies are gearing up to offer their product to a much wider market. SoftwareAdvice.com has updated it's advice on EMR selection with a timely article update on "Should CCHIT Influence Your EHR Selection?"

Anyone thinking about buying an EMR package should read this. It succinctly explains what CCHIT is, and why you need to care what it is. For the uninitiated, CCHIT is the Certification Commission for Healthcare Information Technology, which simply means they say what an EMR has to do to pass muster.

If only it were that simple...

However, if you go on to read the related article on stimulus monies being used to reward adoption of EMR software, the larger picture starts coming in to focus. Roughly twenty billion dollars is sitting in a pot waiting to be given to physicians who become "meaningful users" of "qualified EHR" software.

"Meaningful" and "qualified" are where the rubber hits the road, and these two articles will help you sort through the NewSpeak.

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On a related note, I was forwarded this WP piece this morning: Bad Bet on Medical Records. Long story short, health care professionals (Stephen B. Soumerai and Sumit R. Majumdar) posit there's no clinical evidence that electronicization is a good thing.

"there is little evidence that currently available computerized systems will improve care."

Those of us in the common sense portion of the universe may want to point out that very, very few physicians use EMR, therefore there is, by definition, very little evidence.

Oh, wait.

"The latest national survey, published in the New England Journal of Medicine, shows that only 4 percent of doctors have fully functional electronic records that can provide any kind of clinical recommendations."

They did it for me.

How is this not the bleeding obvious? More worryingly, how is dragging the only industry on the planet currently NOT participating in the Information Age not a bleedingly obvious good thing to do?

Do we *really* need clinical evidence to prove that these new-fangled com-poo-ters are good tools?

As the authors suggest:

"Before moving ahead, the administration should first consider conducting well-controlled research on the cost-effectiveness of health IT in office practices, which are the bulk of the U.S. medical system."

I agree totally.

Lets start by PUTTING SOME SOFTWARE IN THE OFFICE PRACTICES.

I wonder how people so bent on evidence-based judgment for everything park their cars in the morning. I see no clinical evidence on the efficacy of E-mail. In fact, I see plenty of anecdotal and research-based evidence that E-mail can be harmful to efficient work processes. I hope the authors took that into account before sending in their article.

What else? Oh yeh, the system is corrupt.

"Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report "success" than evaluators who had no part in system development."

However, physicians who don't use said software and have their Medicare payments reduced but rail against the use of such software, that's not self-serving at all? Getting rid of these requirements directly impacts every physicians income.

And if you look to your IT developer for success stories, you probably believe everything your car dealer tells you, and I have a bridge I'd like to sell you.

To rephrase the above sentence, we could say that "studies have shown that people who make stuff are three times more likely to say the stuff they make is awesome."

Well, duh.

Let's take a closer look at self-serving protectionism. The authors clearly state that one way they can affirm a positive impact is in single payer systems. This article tells me that for true improvement, we need not only EMR but less players in the market. Do the authors examine the feasibility of a single payer in the US? Of course not, it's business as usual. We have too many players and payers, EMR will never work.

Bah.

But of course, you can't just stand up and complain, you have to think of the children.

"For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won't do much for many Americans. These funds are needed elsewhere."

That old whine. Money is needed elsewhere, so it instantly becomes an either/or argument. This is a logical fallacy at best. Money is needed in LOTS of places. HIT is one of them.

NO-one who wants to spend money on HIT thinks it's the only problem.

It is 2009. We use computers now. We have begged the industry to figure it out, but they can't or won't.

Need clinical evidence that computers are a good thing?

Hmm...

I propose that the physician population start submitting hand-written bills to the insurance companies they work with. And insurance companies should start hand-writing checks to doctors. It'll slow things down a bit, but at least we'll be able to gauge the average physician's love or lack thereof of interconnected data systems.

YES to computerized billing systems so I get paid faster!

NO to electronically storing my patient's data!

Seriously?
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