Junkfood Science: Bar-code healthcare?

March 18, 2009

Bar-code healthcare?

For years, JFS has been warning about plans being made for nationalized electronic medical records, the doublespeak being used to sell them to an unsuspecting public, and their real purposes. While the reality is well-known among medical professionals, the public has been largely kept in the dark, wooed by political and special interest claims and promises. That is beginning to change.

The Wall Street Journal published a hard-hitting Op-Ed by two Harvard Medical School physicians that called out the government for acting the opposite of its promises to the American people to base all policies on rigorous scientific evidence of benefit.

As doctors Jerome Groopman and Pamela Hartzband wrote, the flagship proposal presented by the president at his healthcare summit this month was nationalized electronic medical records — “a computer-based system that would contain every patient's clinical history, laboratory results, and treatments:”

This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill… at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

As Drs. Groopman and Harzband explained, these claims were based on a 2005 hypothetical paper by the Rand Corporation, funded by companies that “stand to financially benefit from such an electronic system.” More importantly, they shared, the policy analysts even readily admitted in their report that “there was no compelling evidence at the time to support their theoretical claims.” To make the it worse, in the years since their report, “considerable data have been obtained that undermine their claims.”

The primary benefit of electronic medical records are the automatic alerts of potential drugs (depending on if the correct dose and drug is even clicked on), but these translate to a relatively small amount of money, nowhere close to $80 billion annual cost savings, as is being claimed. As these doctors explained, most medical errors are not from technical mistakes of doctors writing incorrect prescriptions, but misdiagnosing patients and electronic records have been shown to increase wrong diagnoses: 48 compared to seven when paper charts are used.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error… The real-world use of electronic medical records is quite different from such an idealized vision.

The evidence argues not only against the claims of cost savings, however, but the claims of improved “quality” of care. They went on to share some of the studies that have been reported here, such as of more than 15,000 cardiac patients and another of 1.8 billion ambulatory care visits, finding no association between electronic medical records and improved care. And just two months ago, Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care in seven countries and found “no solid evidence” either way for patients.

But, of course, electronic medical records are not really about improving health outcomes for patients. As has been cautioned at JFS repeatedly, they said:

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called "pay for performance." But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients.

Even before these new data, there were studies casting doubt on the benefits of electronic medical records. In response, the RAND researchers boldly stated, "We choose to interpret reported evidence of negative or no effect of health information technology as likely being attributable to ineffective or not-yet-effective implementation." This flies in the face of the scientific method, where an initial hypothesis needs to be modified or abandoned in the face of contradictory results…

Medical care of human beings... is not analogous to buying bar-coded groceries and checking-account balances online.

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

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