Blog | Tuesday, April 10, 2012

Electronic health records don't cut costs

A new study was published in the journal Health Affairs that reports computerized patient records are unlikely to cut health care costs and might encourage doctors to order more expensive tests.

Save your research dollars, Health Affairs ... I could have told you that!The electronic health record gives doctors information about the patient instantly and helps coordinate care between specialists who are on the same system. Communication and patient safety are improved. Some are built to allow the patient access to their test results and to even make on-line appointments with their doctors. The EHR should create a more accurate record and allow complex data to be aggregated in a way that is understandable. It should create a more efficient system but it will never lower the cost of health care and here is why.

The technology itself is very, very expensive. The cost to an individual doctor to install and maintain the EHR can be tens of thousands of dollars a year and large health systems spend billions of dollars converting from paper to electronic. The promise of eliminating file clerks and paper pushers has been replaced with even more people to enter data, maintain and upgrade the system, and act as scribes for the busy doctor.

Doctors are training now for the new specialty of Medical Informatics and these young physicians will never treat patients. They will deal with data and maintenance of the digital record. It is a booming and richly paid field.

Even the fasted, most facile physician spends more time with the EHR than she did with a paper chart. The documentation is better and more comprehensive, but it is not cheaper. Different systems do not talk with each other and the lack of interoperability is costly. Paper reports still need to be scanned into the EHR and that takes time and money and extra staff.

The EHR should eliminate duplicate ordering of tests when doctors can see what others have done. But there is a culture in medicine where physicians don't "believe" the tests that another doctor or hospital ran. It sounds crazy, but it is true and it drives me crazy when I send the results with a patient and the consultant repeats the tests. The second $2,500 MRI or $600 round of blood panels is rampant in medicine, even when the doctor has the results of a test done that week. (Tip: Patients should refuse a second test if they just had it by a referring doctor.)

There is nothing about digital records that would drive down the cost of ordering more and more expensive tests that are not needed. That is where the cost is. There is nothing that eliminates expensive, futile end of life care or reduces admissions to intensive care units for patients that will never leave the hospital alive. Technology can improve the practice of medicine. We are too fragmented and inefficient and the EHR is an important step for patient safety. Anyone who thinks it will lower costs is living on another planet. There is ample proof that it is more expensive than a paper and pen.

This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.