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Hey Washington Post, Part 2

by Wes Rishel  |  March 29, 2009  |  1 Comment

In Hey, Washington Post, Wake Up! I mentioned several well-reasoned, informed replies to the recent Washington Post note decrying EHRs. I don’t begrudge the Post its need to publish material that grabs attention and runs counter to the thinking of the Administration. I do fault it for ignoring informed responses. I therefore asked the authors to let me publish their letters in my blog so they would at least be on the Internet.

Another thoughful letter directly from the Washington, DC area. Peter Basch, MD, FACP, is an internist in DC is an early adopter of electronic health records and ePrescribing.  He is has a wealth of experience in this area. Peter

  • is the Medical Director for Ambulatory Clinical Systems at MedStar Health, an eight hospital not-for-profit health system in the region where he provides clinical leadership for the MedStar ambulatory EHR implementation. 
  • served as the chairman of the recently concluded Maryland Task Force on EHRs.  
  • is a board member of the eHealth Initiative
  • is a member of the American College of Physicians’ Medical Informatics Subcommittee and also represents the ACP at the Physicians’ EHR Coalition, serving as a member of its Executive Committee. 
  • received the HIMSS Physician IT Leadership Award for 2007.

Here is his letter to the Post.

As a practicing physician and early adopter of electronic health records (EHRs), I appreciate the cautionary statements made by Drs. Soumerai and Majumdar (“Bad Bet on Medical Records,” Tuesday, March 17th, 2009: A15) regarding the potential for harm from poor health IT implementations.  That is why health IT projects must be carefully planned and implemented; paying close attention to existing and new processes of care, as well as being vigilant for unintended consequences.  That said, Drs. Soumerai and Majumdar incorrectly conclude that now is not the time for the Obama administration to invest in health IT.  Their conclusions are based on a combination of outdated studies, and a misinterpretation of several current ones.

First of all, health IT is a very rapidly evolving field – and conclusions drawn from studies that are more than a few years old are really not germane today.  Specifically, outside of a few select institutions, the typical EHR of the early to mid part of this decade did not have the advanced features (clinical decision support) necessary to improve quality to a significant degree.  It should thus surprise no one that studies conducted during that period of time failed to show significant quality improvement. 

And more importantly, even where such features existed, they were almost certainly not fully used, causing some to incorrectly interpret that EHRs are not capable of enabling quality improvement.  The fault here is not with the health IT, but rather with how doctors are paid for their work.  Currently, physicians are paid for doing and not thinking, and volume of services rather than quality.  It is not surprising then that studies of EHRs used in these volume-driven settings of care tend to show a lack of significant public good; and studies conducted in settings where physicians are compensated for health information management and quality outcomes (such as community health centers) show just the opposite.  The key then to seeing consistent improvement in care is not to treat health IT as an end to itself, but rather as a supporting component to care delivery innovation.

Aside from enabling better quality, there are other tangible benefits to EHRs and health IT.  In our practices, for example, all prescriptions and renewals are always checked for drug-drug and drug-allergy interactions, and where possible, are sent electronically to drug stores.   Handouts are easily created for patients; containing instructions, lab orders, and a legible and easily understandable medication list.  Most of our patients feel that their care is better and safer, because of the EHR.

And while good EHRs are already on a trajectory to get better, the stimulus bill will hasten this improvement, as it targets the majority of its dollars not on health IT adoption, but on how health IT is used to make care better.  This is both the right time and the right way to help transition our health care into the 21st century.  This is not a bet on EHRs; this is money wisely invested in our future.  

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Thoughts on Hey Washington Post, Part 2


  1. Mark Frisse says:

    Wes,

    There are so many reasons now for adopting EHR, but how does one reconcile a national approach with the diversity of culture and readiness (not to be confused with an unwarranted variation in care delivery.)

    So much depends on “reasonable use.” I hope you will post your personal views – or some framework for considering that issue – on your blog. Thanks as always for your insights



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