I'm glad to see I'm not the only one noticing that healthcare reform so far has focused only on insurance and not on quality of care. (After all, having health insurance only means that someone else will cover the cost of care--subject to deductibles and exclusions, of course--not that the care you get will be any good.)
In this week's New England Journal of Medicine, Mayo Clinic President Dr. Dennis Cortese writes about how U.S. healthcare needs to look at value rather than just cost. An op-ed in the Washington Post last week rapped President Obama for leaving health IT out of his recent address to a joint session of Congress. (Obama, it should be noted, mentioned EMRs in his visit with David Letterman the other night. Go figure.)
There seems to be some good evidence that EMRs can help provide value by arming doctors with more complete information, clinical decision support and ready access to care guidelines, though the verdict's still out on whether EMRs truly will provide value. That was the gist of the Washington Post piece, written by Johns Hopkins cardiologists Dr. Sammy Zakaria and Dr. David A. Meyerson. "Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities," they write.
Zakaria and Meyerson say that the federal stimulus won't have the intended effect because it's going to cost far more than the allotted sum--they say $50 billion, but the true number is somewhere between $35 billion and $45 billion; the popular $19.2 billion figure is a net estimate based on expected savings--to create a truly interoperable national network. "A cheaper and more effective solution is to adopt a standard electronic record-keeping system and ask that all health information software interface with it," the doctors write. The system they have in mind is the Department of Veterans Affairs' VistA software.
Asking the whole country to switch to VistA--at the expense of long-established private EMR vendors, no doubt--is about as politically feasible as expecting the Republican caucus to throw their unanimous support behind a single-payer health system. It's just not gonna happen. But at least someone's asking the right questions about health reform and EMR usability. - Neil