Time Capsule: Surprise! Below-Average Doctors Use EMRs, Too

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in June 2007.

Surprise! Below-Average Doctors Use EMRs, Too
By Mr. HIStalk

A just-published journal article seems to rip the use of electronic medical records in physician practices. Its conclusion: paper-based doctors hit diabetes quality standards more often than their EMR-wielding colleagues.

From that, you might logically conclude that EMRs don’t provide the outcomes benefits claimed by their vendors. And that, my friends, is why a little bit of information can do a lot of damage.

Observational studies often leave questions unanswered. A researcher observes that Factor A and Factor B co-exist. In a journalistic leap of faith, the conclusion (stated or not) is that one of those must cause the other.

I wish it worked that way. I’d find myself a young, intellectually impotent young lady as a companion. Why? Because you see those women on the arms of rich old guys. Ergo, eye candy makes poor men wealthy. See the fallacy?

Back to the EMR article. I assume the following:

• Caring, competent physicians will find a way to practice good, evidence-based medicine no matter what gadgets they do or don’t have at their disposal.
• Uncaring dolts won’t really get much better just because they have promising toys.
• Those doctors who will get the biggest benefit from information technology are in neither group, that undecided 60 percent who can be pushed either way.

What the article doesn’t tell us is how individual physicians changed after implementing EMRs. Isn’t that what we really want to know? If EMRs improved individual physicians, the rest wouldn’t matter.

Which leads me to these conclusions:

• EMRs can make it easier for physicians in the first category to do the right thing more conveniently. Compliance may go up a shade, as may efficiency.
• EMRs may make less-competent physicians more or less efficient without necessarily improving their adherence to clinical standards.
• Those docs in the middle might be steered and swayed by the path of least resistance to improve their practice, given both EMR technology and the motivation to change (that’s another whole discussion.)

The EMR payback comes from those doctors in the last category. Such systems won’t change the votes of party loyalists, but they can sway the masses of the undecideds.

It’s also not just what you have, but how you use it. Doctor A effectively uses a crappy EMR. Doctor B has the really hot, expensive application, but doesn’t use most of it. Doctor A’s bad EMR may greatly enhance good practice, while Doctor B’s great one may offer no improvement.

Personally, I don’t care whether my doctor uses electronic medical records, pen and paper, or a stone tablet and chisel. His tools are his business. I judge him on my personal outcomes. I expect him to invest in whatever it takes to deliver those outcomes, no different expectations than I would have for a mechanic, masseuse, or chef.

The article will likely cause interesting debate (if for no other reason, it’s a slow news time.) Still, it shouldn’t be a surprise that EMR-wielding doctors don’t necessarily deliver better care.

In fact, it’s actually surprising that anyone finds the study’s conclusions to be inflammatory. Apparently we’ve been sufficiently brainwashed to believe that brushes make the artist. We ought to know better by now.