Sunday, March 1, 2009

A Video On Electronic Health Records Teaches Us About Its Many Shortcomings

The Disease Management Care Blog thinks that Wall Street Journal Health Blog unwittingly posted a highly instructive video that demonstrates much of what is good, bad and downright ugly about the electronic health record (EHR). The posting superficially describes a reporter’s cross country trek and he happened upon an “Ohio primary-care doc” using a record system envisioned by the Obama team. For your viewing pleasure, the video is posted below:

The DMCB deployed its forensic video watching CSI skills and checked for DNA, fingerprints and carpet fibers. Decide for yourself if its interpretation of the evidence will hold up in court:

The Good: the medications can be electronically transmitted to the pharmacy. The physician doesn’t need to write out the scripts and the patient doesn’t need to wait at the pharmacy window. In the opinion of the Disease Management Care Blog, the efficiency, accuracy and safety of EHR-based medication management are its greatest attractions. That being said, the DMCB isn’t sure its opinion would pass muster with the proposed FCCCER, since the evidence may be lacking. There is no shortage of recent studies saying we still have a way to go. So, let’s say it’s potentially good.

The Bad: Just because an EHR is present doesn’t mean there will be evidence-based practice. Case in point? The first patient in the video has shingles and the physician is prescribing valacyclovir (it fights the virus causing the condition) and ‘gabapentin’ to help with the pain. Unfortunately, the use of the latter drug, gabapentin, for the treatment of active shingles is questionable. The DMCB went to the AHRQ’s National Guideline Clearinghouse and found guidelines that suggest opioids – not gabapentin - be used as a first line agent. Not only is there little evidence that it offers all that much compared to the other treatment options, gabapentin is relatively expensive, the evidence that supports its use is troubled and it may be subject to quantity limits. None of that was shared with the patient.

The Ugly: And just where is the business model locally OR nationally? Is this physician any more efficient than the paper-chart-using doctor down the hallway? Is there better care or higher value packed into this office visit? While viewers may be comforted by the physician’s review of the past immunizations (‘flu shot’), the DMCB thinks that is a monumental waste of time. Ample evidence suggests nurses and pharmacists are more than able to use standing protocols to update any missing immunizations. What’s more, the video cleary demonstrates both patients already know about their immunizations and other preventive care needs. The DMCB ran this video several times and cannot find $20 billion worth of healthcare value or much hope of a return on investment as currently configured.

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