Health IT still has many detractors in healthcare

Image removed.Despite the government-led explosion of activity in the health IT field, physician and hospital leaders remain deeply divided about the value of information technology in patient care.

The latest reminder of this came in a Thomson Reuters survey of nearly 3,000 physicians. Asked whether electronic health records would help patients, 39 percent of the doctors said they would; 37 percent said there would be no effect; and 24 percent said EHRs would have a negative impact on care.

In a broader survey of physicians and healthcare executives, 80 percent of the respondents said they thought the widespread adoption of health IT would improve the quality of care and organizational efficiency. But Jim Cramer, CIO of Scottsdale (Ariz.) Healthcare and an advisor on the report, said that many of his peers have doubts about the use of health IT in complex medical situations.

Meanwhile, an analysis of 53 studies on the clinical effects of EHRs found that adoption of health IT systems had not led to major improvements in outcomes, efficiency, or cost effectiveness. But the researchers noted that there were some improvements when healthcare organizations wholeheartedly embraced the technology and customized it to maximize performance.

And yet another study showed that electronic clinical decision support can increase the cost-effectiveness of imaging tests. The use of clinical guidelines for the ordering of these tests caused the number of imaging studies to drop by 23 percent for lower back pain and headache MRIs, and by 26 percent for sinusitis CT exams.

Nevertheless, skepticism abounds. In a Time opinion piece, Dr. Zachary Meisel, an emergency-department physician and Robert Wood Johnson Foundation clinical scholar, noted that health IT is not a panacea for what ails healthcare. While medical errors and unnecessary costs can result if clinical data is unavailable when needed, Meisel said, over-reliance on health IT systems can result in unintended consequences, such as a reduction in collegial discussions about patient care.

There's no doubt that health IT has its drawbacks and that the software must be improved to provide better decision support and interoperability. Too often, EHRs must be extensively customized to fit particular specialties and workflows.

But physician complaints about computers detracting from patient encounters show that many doctors don't yet know how to use EHRs properly. As for doctors not having as much personal contact with colleagues when they depend on EHRs, many primary-care doctors no longer go to the hospital, so they already have less contact with their peers. Moreover, a typical primary-care doctor who treats Medicare patients must coordinate care with 229 other physicians working in 117 different practices. To the extent that EHRs can improve those communications, the records should facilitate collegial consultations.

While today's health IT leaves much to be desired, doctors must make the effort to meet computers halfway if they expect the technology to help them improve care. - Ken

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