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

May 25, 2012 Time Capsule 4 Comments

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.

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Currently there are "4 comments" on this Article:

  1. I’ve sold EMRs in the past and also worked with providers on many other types of systems, so I’ve seen this first hand. I have found that the one who actually pays for the EMR – the doctor – in both cost (acquisition and operation) and disruption of their work flow (thus impacting revenues) actually gain the least benefit from EMRs. Patients and payers benefit the most, but they don’t cover this cost. Not to say that EMRs have no benefit to the practice, but these benefits are more for meeting reporting requirments, etc, than practicing medicine. The old paper chart still works wonderfully. The more an EMR can mimic the doctor’s work – and this primarily means substituting a tablet pc for the paper chart and include handwriting recognition/conversion to data, the more the provider will gain back these benefits. And no, I don’t sell and EMR like that, so I’m not promoting.

  2. C.O.Jones>>> Patients and payers benefit the most…

    Payers may have a lot to gain from the use of EHR, but I don’t see patients gaining anything other than decreased time with their physicians and increased time with physician extenders (s.a. physician assistants and nurse practitioners) who are used in an effort to curb the cost of the EHR rollout.

    I’ve yet to see a well-made unbiased prospective 2 arm study from the EHR industry demonstrating that the EHR improves quality, decreases costs, and decreases errors, all claimed by the current administration as a reason to waste $40 Billion of our tax money on HIT.

    >>> EMR-wielding doctors don’t necessarily deliver better care

    Yes! Agree wholeheartedly, but the **real ** reason for the EHR is not to improve physician care, but to try to keep the future emphasis on the use of physician extenders from killing patients by implimenting algorhythms and “cookbook” medical decision support. Whether it will work has yet to be proven, and this article goes a long way in showing that you can’t digitalize the art of medicine as you can a game of chess and increase quality.

    BTW, do you have the URL for the article?

  3. Not related at all but tell us about the avatar you use. Why the pipe? All this talk about health and that is one of the least healthy think to promote or do!

    [From Mr. HIStalk] Use the search function to find “pipe.” I’ve explained this many, many times.

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