Obama’s Great Health Leap Forward

Mickey Kaus Columnist
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More on the Fantasy Life of Journolists: After I  posted an item about “wonkblogger” Ezra Klein’s confident embrace of Obama’s $19 billion push for electronic medical records, I received several emails from readers who know more than I do. The two excerpted below suggest I was wrong: The effect of the electronic records crusade hasn’t been disappointing, with cost-savings failing to materialize. It’s much worse than that.

From Alert reader #1:

My wife is an overworked Family Doctor and hates electronic medical records.  It was sold as an enormous time saver but turns out to have slowed her down.  She used to be able to talk to a patient, check off boxes on her records form as she spoke to them and say goodbye.  Now instead of checking a box with a pen, she clicks on  a box on her computer screen, waits for it to open, marks the appropriate checkoff, and then closes it.  Repeat .  Repeat.  Repeat. Then close the patients file.  Maintaining eye contact is a thing of the past.  However. Her billing has gone way up.  Things she used to do but never add to her billing are now added automatically because the nanny program prompts her.  I think the electronic records enthusiasts thought that they were pushing best practices.  “Was patient advised about smoking” “ Was the patient counseled about weight loss and diabetes/ hypertension etc” My wife always did these things but never added them to her bill-now she gets paid for doing it.  It seems like electronic proponents were wrong on BOTH of their selling points … [E.A.]

From Alert Reader #2

My wife is a staff physician [at] a major East coast hospital.
Her employer was one of the first to sign up for federal money to implement a system which hospital management freely acknowledges is “terrible” but there was so much money on offer that they couldn’t say no.
Probably the biggest problem with electronic records is simply that it requires the physician to input all notes and orders, rather than dictate them.
As a result, as my bride puts it, “they’ve taken the highest paid person in the department and turned him/her into a data entry clerk”.
On average, she and her colleagues spend more time per patient wading through drop-down menus, clicking boxes and filling in required but utterly irrelevant information than they do at the bedside, actually treating the patient.
In short, it’s her experience that they see fewer patients per shift than they did previously, and spend less time with each one, now that they are required to sit down at a computer after seeing each patient and jumping through hoops to place orders instead of, as previously, simply telling the nurse what is needed and then moving on to the next patient.
But of course things like this always sound good when sales reps are explaining them to bureaucrats. Nobody bothered to actually ask the physicians or to do an independent study to see the results. [E.A.]

Again, it’s possible that electronic records will eventually pay huge benefits, once an entire network (or maybe a better, voice-activated entry system) is in place.  Or it’s possible that Dr. Groopman and Dr. Hartzband’s skepticism will be borne out–and that the real purpose of the electronic database will  not be to help achieve better, efficient care but to justify the government in stopping treatments deemed cost-ineffective.

Some of the early software systems are apparently particularly kludge-y–but that doesn’t get Obama off the hook if, as Emailer #2 suggests, his $19 billion incentive encouraged hospitals to hurriedly adopt these inferior systems in order to get federal cash before the 2014 deadline.

Sounds like so far, so bad …

P.S.: For a breathless, 40%-convincing account of the benefits of “the computerization of medicine” see pp. 442-3 of Michael Grunwald’s The New New Deal. Many of Grunwald’s examples involve improving care–but not necessarily cutting costs, the crucial virtue advertised by Obama.. For instance, electronic records “will help doctors … share MRI results with specialists on the other side of the country instantly …” And these specialists won’t charge for their services? Maybe “digital medicine,” by allowing more star doctors to be consulted more easily, will be a driver of increased costs. …

Mickey Kaus