Blog | Monday, July 22, 2013

Why wonks should read physician-written blogs

Obviously this post is a bit self-serving. However, it does involve some first guessing, rather than second guessing.

Talk to practicing physicians and these two concepts really drive them crazy. (There are others, but today I am just focusing on these two).

Performance measurement has grated on our nerves for a long time. This blog and many others have screamed about the flaws in the concept. We have pointed out the problems repeatedly. Finally, the "leaders" are seeing the light.

Experts in quality improvement developed an important paper for the Robert Wood Johnson Foundation. (I blogged about this on June 6.) In that paper, Achieving the Potential of Health Care Performance Measures, the authors point out many of the flaws that bloggers have noted for many years. Our concerns now are getting serious attention.

Now in the Annals of Internal Medicine, Koppel writes about "Demanding Utility From Health Information Technology."

Their results suggest that EHRs currently fail to meet the anticipated goals, an observation that is particularly disheartening when one recognizes that the study population likely reflects the views of more enthusiastic EHR users.


They had to do a study. They could have read many blogs and suspected the same thing. Koppel finished his commentary:

"In light of these findings, addressing health information technology's Tower of Babel will require redirection of our focus on data standards and integration. The U.S. government pays approximately 52% of all health care dollars, which can provide robust motivation for such refocusing. Regulators already have authority to demand data standards and interoperability. Ideally, vendors will cooperate. Current policy puts faith in market processes, incremental changes, and regulatory hints to achieve data standards, interoperability, and usability. DesRoches and colleagues reveal that such faith is chimerical. The necessity to improve care and reduce costs is too compelling to allow the current chaos to continue. This study shows that if EHRs are to fulfill their promise, we must shift from cheering health information technology implementations to demanding health information technology utility."

The wonks should talk to some real physicians to get an idea about unintended consequences. The good physicians who see patients daily understand practice very well. Why don't the beltway boys listen to them?

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.