There's a lot of talk about the wonders of electronic medical records, a lot of attention to the fatal mistakes they'll prevent and the money they'll save. But for all the glittering hype, the reality is that they're being implemented at a snail's pace. Kevin Pho -- also known as Kevin MD, a blogger I don't often agree with -- explains why:
All in all, a sad scene, and an indictment of our system. It's also pretty weird. If you walked into a bank, and asked to open a deposit, and they lifted a huge ledger book from the shelf and began turning pages till they got to your letter in the alphabet, you'd walk out the door and never return. The fact that doctor's offices keep life-and-death information in manila file folders, however, just seems...normal. The fact that we can't access our records online, or e-mail them to a specialist: All normal. But it's not. In fact, it's crazy. And we're wasting too much money and letting too many people die as we wait for the market to take this one up naturally. It's long past time for the government to step in and put forward the cash -- and interoperability standards -- to get it done.Additionally, many of the software options are needlessly restrictive -- reliant on "yes or no" questions -- and few of the platforms can talk to one another, a particular problem given our fractured health system.
The New England Journal of Medicine recently found that only 13% of physicians had made the transition to an electronic record system. The primary reason is financial. Upfront costs — which include purchasing servers, computers and software — can be as high as $36,000 per physician.In addition, the learning curve for these programs is steep, increasing the amount of time a physician spends per patient.For their efforts, doctors receive only 11% of the savings from electronic records, with most of the savings going to health insurance companies and the government...David Brailer, former national health information technology coordinator in the Bush administration, puts it best: "The doctors bear all the costs, and others reap most of the benefit."In other words, it's something of a collective action problem. We'd all be better off with wide adoption of electronic medical records. But it's not in the direct interest of any of the relevant agents to actually pay the money to implement the systems. This is, put simply, the reason we have this thing called "a government," which helps us solve problems like this one. Indeed, as Kevin notes, the most successful adoption of EMRs was in the Veteran's Health Administration; the socialized health care system where the government owns the hospitals and employs the staff and funds the infrastructure. The result? "Reduction of medical errors, optimization of cost efficiency, and attainment of high scores in preventive care measures." And incidentally, this isn't an isolated finding. In most countries with government-run health care, adoption of electronic records is far higher than in the US, as the following graph from a Commonwealth report shows:
All in all, a sad scene, and an indictment of our system. It's also pretty weird. If you walked into a bank, and asked to open a deposit, and they lifted a huge ledger book from the shelf and began turning pages till they got to your letter in the alphabet, you'd walk out the door and never return. The fact that doctor's offices keep life-and-death information in manila file folders, however, just seems...normal. The fact that we can't access our records online, or e-mail them to a specialist: All normal. But it's not. In fact, it's crazy. And we're wasting too much money and letting too many people die as we wait for the market to take this one up naturally. It's long past time for the government to step in and put forward the cash -- and interoperability standards -- to get it done.Additionally, many of the software options are needlessly restrictive -- reliant on "yes or no" questions -- and few of the platforms can talk to one another, a particular problem given our fractured health system. 
