Electronic Medical Records Under Senate Scrutiny

Steve Lohr's article for the New York Times this week, "Smart Care via a Mouse, but What Will It Cost?" highlights the support expected from politicians as a bill meanders through senate committee. It touches on a number of interesting points concerning electronic medical record (EMR) cost, quality and research.

One concern highlighted is the potential for increased costs for providing care as improved record keeping uncovers inadvertent lapses in regular health care maintenance and management of chronic diseases. I'd argue that these up-front increased costs are acceptable to take since the U.S. Preventive Services Task Force (USPSTF) who creates these guidelines takes into account the cost-benefit ratio. That is to say, USPSTF issues guidelines with the expectation that the costs of implementing preventive care will decrease the cost of future complications, as well as be an acceptable cost in our society's culture for the value we place in the health received.

Another concern is increased costs by "providing more care for more people" since unserved populations could be alerted to the fact that a drug or therapy is available for them. I'd argue that if those treatments truly give those people better health, then that's great! Again, our society places a high value on health, which is why many people have broad options within their health insurance plans to pursue various treatments.

One potential cost savings highlighted is the potential for research from EMRs to support the use of cheaper drugs. Kaiser uses lovastatin, a generic drug that is appropriate for many people with high cholesterol. The leading drug in this class is Lipitor (disclosure: I take it), which costs a lot more since it's a branded medication, and the most potent in it's class. Research gleaned from de-identified data from EMRs could support the use of the lower cost medication if it showed similarly good outcomes when used at higher doses, as compared to the more potent Lipitor. Kaiser claims that it does have that evidence. I'm curious how, since they've just recently started to implement Epic's EMR (disclosure: I use it daily). I suspect they collected the data painstakingly by hand from paper records. I'm glad that going forward they'll have an easier time at supporting these worthy research goals.

A final example is a bit more fanciful. Marshfield Clinic researchers claim that by personalizing drug dosing according to genetic profiles, quality and safety will increase. The drug in question is warfarin, a blood thinner, which is notoriously tricky to keep therapeutic, but not thin the blood too much. Too little warfarin and your blood is too thick. Too much warfarin and you will bleed dangerously easily. I'd argue that it's more important to get your care from a good clinic that monitors the thinness of your blood very regularly, rather than figure out your genetic profile to be able to get the dose right initially. I'm not saying it wouldn't be helpful, it's just that keeping you at the right blood thickness has less to do with the initial dosing, than the ongoing monitoring and adjustment of dosing.

I'm a supporter of EMRs, heck, I use them everyday. I just would like to see more acceptance of the fact that better care costs more money. Money that our society deems an acceptable burden, one that is smart money that decreases costs of chronic care in the long run.



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42 folks' comments are tracked by technorati:
Sydney Smith of Medpundit has this to say: "So, has it come to this? We need to invest in expensive computer software to counteract sophisticated drug industry marketing? Jeesh." With 5 commenters on her post.
Al Hawkins laps at the kool aid: "Glossed over are the potential for increased patient safety (by having charts readily accessible and legible), convenience (making your records available to whatever care provider you are currently seeing), and awareness (helping you track the course of your illness along with your health care provider)... No, it's not a panacea. There are a lot of problems with 21st century health care, and those problems exist in every single industrialized country in the world. EMRs can help root out inefficiencies and catch small mistakes before they become big ones."
David Ermer supports EMRs
Healthcare IT bets on EMR saving money.
George Chinnery worries about privacy.

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