Health records need progress

Electronic medical records are supposed to cut costs and simultaneously improve care.
But there are problems with both those goals.
Doctor’s offices and hospitals are having a hard time making the transition to medical records that can be easily, yet securely, shared from site to site. “Our systems don’t talk to each other,” said the chief of staff for a large Veterans Affairs’ Medical Center.
As for improved care? A new study provides a shocking conclusion: In at least one form of medical record-keeping, even when doctors are electronically alerted to suspicious test results the innovation does not seem to reduce the rate of errors.
The chief advantage of electronic records as first touted was that they would be easily portable — transferable from office to office to hospital as patients moved from, say, their general practitioner to a specialist to the operating room at an out-of-state surgical center.
But physicians and hospitals still haven’t figured out how to interface among numerous different record-keeping databanks. Some progress is being made on a piecemeal basis: A sub-industry has been spawned as new software companies spring up to create and market interface systems. The private sector is “eating the elephant one bite at a time,” said Carla Smith, executive vice president of the Healthcare Information and Management Systems Society.
Washington has said it does not want to mandate a single system, but it has made some stimulus funding contingent on use of electronic records. And if progress isn’t substantial by 2014, Congress may yet step in.
But technological difficulties aren’t the only, or even the biggest, problem. After all, it’s easier to solve tech problems than it is to alter human behavior.
A study in the Archives of Internal Medicine shows that doctors actually may be less likely to act on errors spotted through electronic record-keeping programs. The study focused on 123,638 imaging tests (X-rays, etc.) at a Veterans Administration facility.
The VA has one of the nation’s more sophisticated electronic records systems, notwithstanding the difficulty in sharing information from facility to facility. The system provides automatic alerts on suspicious test results. But the study showed that the alerts often were not even looked at promptly. Worse, when they were reviewed, they often were not acted upon.
The study suggests the following causes: Busy doctors are overwhelmed by data and the alerts get lost in the electronic noise of their jobs. Or, doctors assume someone else, such as the radiologist who read the test, has taken care of the problem.
It recommends, among other things, that electronic alerts specify a clear chain of accountability and require a doctor to provide an action plan, or at least a signature, before he can clear an opened alert from his screen.
Electronic record-keeping is proving an elusive remedy for big medicine’s ills. With only about 10 percent of American health care providers using electronic records, the industry is far from achieving anything close to utility on this important program.
And, as a study suggests, even when technological utility is achieved, there must be added safeguards to ensure that health care providers use the system in a way that best serves patients.