The causes of the crapification are legion, but one that is having a bigger impact on health care than is widely recognized is bad information technology implementation. And I dont mean the healthcare.gov website.

In case you missed it, the Federal government is in the midst of a $1 trillion experiment to promote (as in force) the use of Electronic Health Care records, or EHRs. Astonishingly, this program has been launched with no evidence to support the idea that rendering records in electronic form will save patient lives. From a Freedom of Information Act filing by the American Association for Physicians and Surgeons got this response, which was reprinted in their April newsletter (emphasis ours):

The American Recovery and Reinvestment Act of 2009 (ARRA) created the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. While our Office of E-Health Standards and Services works to implement the provisions of the ARRA, we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives.

Now of course, one might argue based on intuition that surely electronic data would help patient care. Think of all those illegible doctor scrawls that get misread from time to time. But you need to weigh those errors against those of bad data entry, difficult to read file formats, difficulty in converting records to electronic form, and greater risk of loss of patient data (hard disk crashes and faulty backups).

In fact, Ive seen good health care information technology in action. When I lived in Sydney in 2002 to 2004, every doctor I saw had a little black flat panel screen in their office or examination room, and most would enter data during the session. The doctors I saw were in solo or small practices. Their fee levels (assuming a dollar for dollar exchange rate, which was not the case at the time) were 25% to 35% of New York City rates for comparable services. That suggests that the use of IT wasnt a costly addition to their practice overheads.

But could the US adopt the sensible course, which would be to look for successful health care information technology implementations overseas and learn from them? No way. As Informatics MD notes at the Health Care Renewal blog (emphasis ours):

I know from personal development and implementation experience that when done well, that is, when good health IT and good implementation practices are offered and with patient safety as a priority, health IT can save lives and improve care. Its just that the commercial for-profit health IT sector does not meet those expectations, due largely to its leadership model from the merchant-computing culture. Instead, bad health IT is the norm.

Well get to the lousy patient outcomes part in due course. But I wanted to focus on a less obvious but no less significant element of this health care information technology push: that it is accelerating the death of solo practices. Mind you, this was already well underway, as reader Juneau noted in our recent post on corporatized medicine:

Going from working for a large corporate healthcare entity to working alone, I have seen insurance rates cut by 40 percent simply for going from group to solo status. Those who can afford to do it right (maybe those without kids or a mortgage or 3 divorces to pay for) feel like dopes. Colleagues who put themselves first survive. Those who made sacrifices, provide free care to indigent patients, accept insurance, etc..are now the low tier low status docs who work 60 plus hours to make overhead and stay afloat.

This article from UTSanDiego explains the impact of the health care information technology requirements from the doctor perspective:

See the original post here:

Health Care Information Technology: A Danger to Physicians and to Your Health