21st Century Medicine Using 20th Century IT

According to a survey, published online by the New England Journal of Medicine on June 18th, 2008, of over 2,700 physicians, just 17% of respondents are using EHRs in their ambulatory care practice. This contrasts with more than 90% of similar physicians in the Netherlands, Australia, New Zealand and Britain. EHR adoption remains at a slow pace. It is clear that President Bush’s goal of securing an EHR for every citizen by 2014 is beyond reach.

The World Health Organization ranked the United States 37th overall on measure of quality and access to care. This is in contrast to our ranking as number one in health care spending per capita with a total expenditure of over $2 trillion or more than 16% of GDP. Using 20th century IT – pen and paper – in the 21st century unexpectedly delivers such disappointing results.
The survey of physicians revealed some interesting results. They include:
 

• Physicians believe EHRs improve quality
• Financial factors are a barrier to physician adoption of EHRs
• Clinical decision support systems (CDSS) reduces the number of medical errors
• Externalities and Adverse Incentives

Using the words of economists, the failure to account for the externalities and adverse incentives inherent in our employer-based healthcare delivery system presents a marketplace that delivers poor outcomes, inefficiencies and problems in access. For HIT, this means that the costs of implementing an EHR accrue to the physician while the large majority of the benefits from an EHR – better quality of care and cost savings – accrue to the patient and the payor.

By adjusting the market through regulations and/or investment, these governments attempt to control externalities to foster aligned incentives that drive good behavior – the adoption of EHRs by physicians. Until the U.S. adjusts the misaligned incentives and removes the moral hazards inherent in its free-wheeling employer-based healthcare reimbursement system, its citizens cannot reasonably expect to benefit from the widespread deployment of EHRs.

My full article on this subject can be foundon the WTN website at wistechnology.com/articles/4848/