Wednesday, July 6, 2011

Parallels Between The Lessons of "Reckless Endangerment" and the Ideological Promotion of the Electronic Health Record

The Disease Management Care Blog is avidly reading the page-turner "Reckless Endangerment."  In it, authors Gretchen Morgenson and Joshua Rosner vividly describe the decade-long assumptions and hubris that fueled a reckless home-ownership ideology.  Convinced that manipulating mortgages and lowering lending standards would promote middle and lower class prosperity, government and parts of the finance industry ultimately created a housing black hole that is still with us today: millions of Americans are not only stuck with property that is "below water," but lingering  "un" and "under" employment that is reaching historical proportions.

While the DMCB understood the vague outlines of what happened, the real insight it has gained from this book is how awful things can happen when a President, both parties in Congress and an entire regulated industry combine to promote semi-public "partnerships."  Despite occasional warnings from some smart economists on the fringes, the "a home for every American" borg sucked caution of the room faster than U.S. Representative Barney Frank could speed-dial his buddies in Fannie Mae.

Which reminds the DMCB of a parallel borg called the electronic health record (EHR). A eerily  similar bipartisan government-industry ideology has somehow decreed that EHRs will increase clinical quality, enhance efficiency, promote safety and reduce costs.  While the downsides of a miscalculation don't come close the magnitude of a "Too Big To Fail" disaster, that doesn't mean we won't be left with a lot of ill-suited and expensive legacy information technology systems that do little to make medical care any better than it already is.

Case in point is this recent publication appearing in JAMIA.  While the DMCB awaits a reprint request so it can dive into the details, the methodology seems simple enough: a "clinician panel" looked at the appropriateness of 3850 consecutive electronic prescriptions forwarded to a large pharmacy chain. They found at least one error in a whopping 11.7%.  While omitted information was the most common mistake, a potential "adverse drug event" accounted for a third of the mistakes.  The authors point out the interesting statistic that an approximate 12% error rate is about the same that's been reported for hand-written prescriptions.

And this is what we're spending our national treasure on?  Egads.

While Americans bemoan partisan gridlock, an allegedly rudderless Presidency, complex regulations and uncooperative private industry, the DMCB is learning to fear its opposite: a confidently wrong Chief Executive backed by an enthusiastic and misinformed Congress that bulldozes its way through economic sectors like the healthcare industry. 

No comments: