Electronic medical records not seen as a cure-all
As White House pushes expansion, critics cite errors, drop-off in care
Sunday, October 25, 2009
In a health-care debate characterized by partisan bickering, most lawmakers agree on one thing: American medicine needs to go digital.
When President Obama designated $19.5 billion to expand the use of electronic medical records, former House speaker Newt Gingrich (R-Ga.) said it was one of only "two good things" in February's stimulus package.
But such bipartisan enthusiasm has obscured questions about the effectiveness of health information technology products, critics say. Interviews with more than two dozen doctors, academics, patients and computer programmers suggest that computer systems can increase errors, add hours to doctors' workloads and compromise patient care.
"Health IT can be beneficial, but many current systems are clunky, counterintuitive and in some cases dangerous," said Ross Koppel, a sociologist at the University of Pennsylvania School of Medicine who published a key study on electronic medical records in 2005.
Under the stimulus program, hospitals and physicians can claim millions of dollars for IT purchases, and will be penalized if they do not go digital by 2015. Obama has said the changes will save billions and will minimize medication errors.
But health IT's effectiveness is unclear. Researchers at the University of Minnesota found in March that electronic records prevented only two infections a year. A 2005 report in the journal Pediatrics found that deaths at the children's hospital at the University of Pittsburgh Medical Center more than doubled in the five months after a computerized order-entry system went online. UPMC said the study had not found that technology caused the rise in mortality and maintained that medication errors were down 60 percent since computers were introduced in 2002.
Others studies have concluded that health IT saves time and reduces errors. It has been used successfully in organizations such as the Department of Veterans Affairs and Kaiser Permanente.
Documenting the flaws
However, the Senate Finance Committee has amassed a thick file of testimony alleging serious computer flaws from doctors, patients and engineers unhappy with current systems.
On Oct. 16, the panel wrote to 10 major sellers of electronic record systems, demanding to know, for example, what steps they had taken to safeguard patients. "Every accountability measure ought to be used to track the stimulus money invested in health information technology," said Sen. Charles E. Grassley (Iowa), the panel's ranking Republican.
Anonymous reports sent to the Joint Commission, the body charged with certifying 17,000 health-care organizations; Grassley's staff; and the Food and Drug Administration disclose problems, including:
-- Faulty software that miscalculated intracranial pressures and mixed up kilograms and pounds.
-- A computer system that systematically gave adult doses of medications to children.