Asked and Answered

by Dave Schuler on January 18, 2013

Mickey Kaus asks:

Did he really believe it?

That is, did Ezra Klein really believe that electronic medical recordkeeping would actually reduce healthcare costs?

I think he did. When you’re young enough, don’t actually know anything about the subject, don’t have the life experience necessary to distinguish between vapor and reality, and believing something will help you while questioning it will hurt you, you can believe darned near anything.

I sincerely believe that nobody in the healthcare field who wasn’t actually selling electronic medical recordkeeping systems really believed that such systems would lower costs.

{ 9 comments… read them below or add one }

Icepick January 18, 2013 at 2:51 pm

I sincerely believe that nobody in the healthcare field who wasn’t actually selling electronic medical recordkeeping systems really believed that such systems would lower costs.

LOL! I think you under-estimate those selling the e-med-rec stuff – I bet a lot of them didn’t believe it either!

I remember when our primary switched to e-med-recs and took the whole office electronic. It seemed like a good enough idea, and hey, Rxs would be done electronically. He’d fill them out on his portable device, send them over to the staff, they’d check with me when I was leaving to see which pharmacy to send it to and zap it on over. No illegible writing, not paper of any kind to deal with, and since my doctor is on the other end of town and my pharmacy is on this end, the meds would be ready when I got near home. Perfect!

Since then I’ve had nothing but trouble getting Rxs filled. The doctor’s system seems to glitch with the pharmacy’s system. In the last couple of months we all got some nasty bug or another and I had to go to the doc several times. The first time I was so sick I forgot to ask for paper copies of the Rxs. It ended up taking about eight phone calls and two days to get the damned Rxs filled. GRRR.

But, you know, efficiency! And less paper! Environmentally friendly! Now if I can just avoid dying from driving back and forth across town while deathly ill to get my freakin’ Rxs filled it will be AWeSOMe!

steve January 18, 2013 at 9:17 pm

“I sincerely believe that nobody in the healthcare field who wasn’t actually selling electronic medical recordkeeping systems really believed that such systems would lower costs.”

He probably assumed that the private sector would come out with something at least as good as the VA system.

Steve

Andy January 18, 2013 at 11:09 pm

In the military we have two records: A hard-copy medical record and an electronic record. Actually three records, because I also have my own record (Hard experience taught me that things get “lost,” like the year I had to get three flu shots). Somehow I doubt three records is going to be cheaper than one regardless of the system.

And a big problem, like so much of medicine, is that electronic medical records don’t consider patients. A good electronic system must give us access to our own medical information – it’s not enough to be easy and convenient for health care workers.

Dave Schuler January 19, 2013 at 7:39 am

He probably assumed that the private sector would come out with something at least as good as the VA system

Nah. I just assumed that salesmen, at least good ones, always believe in what they’re selling no matter how crazy or unsuitable to task it is.

Dave Schuler January 19, 2013 at 7:52 am

it’s not enough to be easy and convenient for health care workers.

Andy, they’re not even that, as I’m sure steve can attest. What they are is easy and convenient for software developers.

I’ve seen several such systems (including the industry leader) and looked at them fairly closely. They’re all web-based, either intranet or using the public Internet, something I find a bit problematic on the face of it. I’ve also seen medical professionals fumble endlessly trying to use them.

There are basic things necessary for usability that they’re missing like coherent and intuitive interfaces, “kits” e.g. sub-assemblies of commonly-combined things, context-sensitive prompts. I could go on practically forever.

Also, I don’t think that any of them could stand up to a serious security audit by a knowledgeable, disinterested person. That’s amazing given HIPAA.

steve January 19, 2013 at 2:19 pm

“There are basic things necessary for usability that they’re missing like coherent and intuitive interfaces, “kits” e.g. sub-assemblies of commonly-combined things, context-sensitive prompts. I could go on practically forever.”

When they try to do this, they invariably forget to leave a “blank” slot for things they forgot to cover in their order sets. If I need to order something they dont have on “the list”, I can’t do it sometimes.

Steve

Dave Schuler January 19, 2013 at 2:40 pm

The way such things should work is that the user should be able to create his or her own “lists” for future use.

Sam January 21, 2013 at 10:02 am

The mistake was to assume a technology in its infancy would amazingly come together and form a standard interchangeable medical record. I think Ezra was dreaming of a patient-based embedded chip with your genome and entire medical history, standardized and readable whenever you walk into a new doctor. Something like that will happen someday, and it will increase productivity.
If the patient owns the record, there will be far more demand for interchangeability. As it stands now, why enable your competition unless coerced?

Dave Schuler January 21, 2013 at 10:04 am

Good point, Sam. I would also note that not only do superior technologies not always prevail, if they prevail it’s a coincidence. Marketing and salesmanship prevail, not superior technology. Increasingly, it’s whichever company has the better connections that prevails.

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