State Health Care Reform: Key Questions and Answers
Table of Contents
- Executive Summary
- Introduction
- Do We Need Individual Mandates?
- Should Government Decide How Medicine Should Be Practiced?
- Does Universal Coverage Lower Health Care Costs?
- What Is the Best Use of Government’s Health Care Dollars?
- Should We Encourage Consumer-Directed Health Reforms?
- Are Electronic Medical Records The Answer?
- Are Guaranteed Issue and Community Rating the Answer?
- Is a Massachusetts-Style Connector Part of the Answer?
- Does Modeling by the Lewin Group Bias State Choices?
- Notes
- Appendix A
- Appendix B
- Appendix C
- About the Authors
Are Electronic Medical Records The Answer?
Despite the assertion that centralized electronic medical records will cut costs, supporting evidence is lacking. Such data systems have yet to prove themselves in practice.26
The evidence to date suggests that electronic medical records will increase the risk of misuse of individual health information. Identity theft is already common. New criminal uses of individual health information include using someone else’s name to get expensive health care services, or attempting to extort money from employers by threatening to publish patient records. A threat to breach patient confidentiality could lead to serious penalties under the 1996 Health Insurance Portability and Accountability Act (HIPAA), one of the goals of which was to ensure the privacy of patients’ medical records.
Electronic records also increase the risk to state taxpayers, who could be liable for damages caused by stolen or misused records. The Veterans Health Administration, long praised for its electronic records, has repeatedly lost sensitive data on millions of patients and has spent tens of millions of dollars repairing the damage caused by such thefts.27
Although popular mythology assumes that electronic records will reduce costs, the evidence from hospital-based systems is mixed. Hospital-based computerized order-entry systems for prescription drugs do appear to reduce medication prescribing errors, but at the possible cost of increased workloads and decreased human vigilance against error. Experts fear that this combination may harm patients in situations when rapid treatment is essential. There are scant data on whether electronic prescribing records improve health outcomes, and a small but growing literature on the new kinds of errors they facilitate.28
"There is little evidence that electronic prescribing improves health outcomes."
Other problems with electronic records include how to control the propagation of errors, and differences between clinical and administrative records. Medical records contain errors, and those errors are neither reduced nor corrected by computerizing them. A November 21, 2007, Associated Press article described the errors that physicians found in their own medical records.29 HIPAA does not require those who maintain health records to correct them. There are important questions about who should have the authority to alter electronic patient records. Data system robustness is a concern. There are also studies that have found that the records themselves change behavior. In the Veterans Health Administration system, a significant number of patient records have case notes that are electronically copied from one record to another in order to save time. The electronic medical records that result are bloated and obfuscated. They waste physician time, are inefficient, and do a poor job of rapidly conveying important clinical information.30
A final problem is that the drive to use patient records for billing and monitoring may degrade their usefulness in patient care. Patient records were originally developed to help clinicians provide care. If administrators insist on standardizing them in order to use them for process control and provider evaluation, it is likely that clinicians will respond by not keeping notes that can be used against them. In Britain, hospital trusts have “adjusted” patient records in order to suggest that patients had been treated on time.31 In the United States, physicians already keep multiple sets of records. One is in the format demanded by payers like Medicare. The other may be private notes that suit a physician’s personal style and helps him facilitate patient care.
