March 17, 2009

FIRST...HARM:

Bad Bet on Medical Records (Stephen B. Soumerai and Sumit R. Majumdar, March 17, 2009, Washington Post)

The recently enacted stimulus package included $20 billion for health IT, and, indeed, the $50 billion the administration initially earmarked is almost twice the annual budget of the National Institutes of Health. Yet while this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. In short, it's the wrong investment to make at this time.

The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. It is true that computerized records in some settings might improve care, such as by preventing duplicative prescriptions, medical errors caused by illegible handwriting and even inappropriate treatments. But the benefits of health IT have been greatly exaggerated. Large, randomized controlled studies -- the "gold standard" of evidence -- in this country and Britain have found that electronic records with computerized decision support did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma. While computerized systems seek to reduce the overapplication or misuse of care, they do little to prompt greater and more widespread health-care practices that are known to be effective. Health IT has not been proven to save money. [...]

What's more, evidence suggests that adoption of some computerized systems has not helped but harmed patients. After the Children's Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients. Another leading system contributed to more than 20 different types of medical errors.

Posted by Orrin Judd at March 17, 2009 6:28 AM
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