I just finished reading Why the healthcare system doesn’t want electronic medical records on Techdirt, and I have to say, I don’t buy it. The article proposes that some vast conspiracy designed to fleece the public through deliberate inefficiencies is at the root of the push back against going digital.
I’ve spent a more than dozen years now in various places within the healthcare landscape and I can tell you we’re not organized and coordinated enough to pull something like that off.
In all seriousness though, the problem is very real. But it just doesn’t derive from anything so pernicious as a raw profit motive. It’s much more about misalignment of incentives. Let’s look at this in a different way:
- This healthcare “system” of which you speak — it doesn’t exist (except in a small number of cases and markets)
- Hospitals have, for the most part, adopted electronic records. Those that are large enough have the kinds of inefficiencies that make such a decision easier.
The push back has come more from the physician community, so let’s look at why that is:
- We’ve largely asked the physicians to pick up the costs of these systems for their practices
- In many cases, they make the physician less efficient
- Other places in the system (the insurers, for example) see more of the benefit
- No one has reimbursed them for the trouble
Given, this isn’t as true now as it was in the past. So what’s still standing in the way?
- The long-term goal of electronic records isn’t storing the data electronically, rather it’s to change the way that physicians practice medicine
This is the concern. Doctors value their autonomy. They didn’t spend all those years in medical school so that some kid in IT could tell them how to practice medicine.
You don’t think so? What do you think evidence-based medicine and pay for performance are all about? They dictate how doctors should treat patients. None of that can work without a system that captures data, delivers direction and allows for reporting for accountability.
When you look at the disparities in the way patients are treated from doctor to doctor and state to state it becomes obvious that this is the inevitable direction.
So why are we looking at a growing list of financial incentives to go electronic? Why should that be necessary to do what seems obvious from the start?
The reason is that no one gives up control willingly unless someone makes it worthwhile for them. As that reality has been accepted, the tools have begun to fall into place to make that happen.