e-Doubts on Health Information Technology Part 2: Other e-Doubters Weigh In

What’s going on? Since the e-Doubt post, the Disease Management Care Blog is becoming aware of the beginning of a bloggy backlash against electronic health and medical health records. It doesn’t usually write about other blogs (preferring instead to read them) but it appears there’s a critical mass of skepticism in two of the more highly regarded independent health policy blogs.

In this erudite December 17 post in the Health Care Blog, Rick Peters likens healthcare information technology (IT) and its EHR mainframe mentality to the inept U.S. auto industry, only worse. There is one difference though: at least Detroit didn’t try to set up ‘standards’ that unfairly perpetuate their bloated business models. He offers up some extremely sensible, lean and targeted funding suggestions that go far beyond the generalities of the DMCB’s Dec 16 post. He proposes that the Obama Team resist the siren call of EHR zealots and create specific targeted challenge awards that promote scalable, ‘cloud-based’ web-based, secure and open source IT systems that separately accomplish a) insurance claims processing, b) eligibility and claims remittances, c) ePrescribing and order entry, d) laboratory and test reporting and e) decision support. The winners will be rewarded by having all insurers including CMS be mandated to use them. The DMCB says bravo.

In retrospect, the DMCB should have suspected something was up when even blogmaster and e-sage Matthew Holt in this post in the same Health Care Blog noted the electronic health record is ‘not the be all and end all.’ The DMCB likes his concept of limited, mutually supportive and swappable specific ‘applications’ that are designed to either record, personalize, analyze, provide decision support or enable transactions. The DMCB says he who is without the sin of second thoughts should throw the first stone.

And even the taciturn and laconic Maggie Mahr of the HealthBeatBlog wonders if it’s time to call a halt to the e-irrational e-exuberance. Quoting au correspondent several scarred veterans of the healthcare IT contretemps, she discovers real physicians, i.e., the ones that actually take care of patients, don’t necessarily like having EHRs. What’s more, there are a host of other problems including the lack of a business case for interoperability, logarithmic degrees of complexity and toxic levels of radiovendoractivity.

And it may not be just the blogs. According to the December 12 Health Care Renewal post, eternal e-skeptic Scot Silverstein (one of the experts quoted by Maggie Mahr above) points out that the Joint Commission doesn’t buy into the assertion that health information technology is synonymous with safety. In fact, it can be synonymous with mislabeled bar codes, confusing screen displays, poor adaptation to work flows and dysfunctional impacts from loss of professional autonomy. It recommends that safety programs for the EHR be established and has a series of specific suggestions ultimately designed to keep patients from being added to the 98,000 getting killed every year.

The DMCB supposes there may be merit (maybe not) to the overall notion of stimulus spending and, given the percent GDP footprint of healthcare, funneling some serious coin toward health care IT reform would be a heckuva jobs program. Given the insights of Rick Peters, Matthew Holt, Scot Silverstein and the Joint Commission above, perhaps it’s time to ask President Elect Obama and Secretary Nominee Daschle to pause and think again. Can they can really be so confident that $50 billion is a wise investment?