EMRs must be viewed in a wider context

I stirred up no small amount of controversy last week when I took the pundit class to task for missing many of the issues related to EMRs and health IT, particularly since I took my most pointed shots at Bill O'Reilly and his colleagues at Fox News Channel. I got one email from an Alaska government employee requesting that we cancel his subscription. "I don't need another liberal know-nothing lecturing me on how to think!" the writer said. 

OK, at the risk of sounding like a conservative know-nothing lecturing people on how to think, I'm going to criticize something that CNNMoney.com reported last Friday: how it's been a slow process for St. Elizabeth Healthcare in Kentucky to install and make interoperable an EMR for three hospitals and 43 clinics, a three-year effort projected to cost $80 million. More specifically, I'm going to take issue with the fact that CNN neglected to report what the payoff will be: 24/7 clinician and patient access to medical records, regardless of care setting; a reduction in duplicative tests; better care planning; streamlined appointment scheduling; and hopefully, a higher quality of care at lower cost.

This we learn only from Healthcare IT News, which lifted much of the information from an IBM press release. (This is an ironic development of itself, in that IBM's contract with St. Elizabeth is only worth $1.5 million, according to CNN. Epic Systems accounts for half the total $80 million pricetag.)

The theme of the CNN piece was that every healthcare organization will have a different experience when it comes to implementing an EMR--something that everyone with an inkling of knowledge about the health IT industry already knows. Still, the more stories like this that come out, the more other providers will have to learn from earlier adopters. We'll see if this comes in time to save Sac-Osage Hospital in Osceola, MO.

An Associated Press story highlights how the small, rural facility hopes to stay in business only by the grace of an expected $3 million "windfall" from the federal stimulus. The reporter talks EMR business with the American Hospital Association's Rod Piechowski and mentions the HIMSS Analytics EMR adoption scale, but like so many others in the mainstream media, discusses the EMR issue in isolation.

People, IT is an important part of comprehensive health reform. It's not always about short-term costs. It's about improving care and eventually reducing costs by keeping people healthier. Eliminating duplication is a good way to control expenditures, and EMRs can help with that, as St. Elizabeth is attempting to prove. But much of the unnecessary testing is the result of defensive medicine, a symptom of a litigation-happy society. Liability needs to be part of the discussion, too, whether you favor tort reform, caps on awards or simply reducing the risk of errors. Healthcare already is too fragmented.

Reform must remedy, not perpetuate, the fragmentation. - Neil