The Use and Misuse of Information Technology in Health Care

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massive incentives and concomitant penalties because the products that are available work so poorly and are so severely user-unfriendly. Using the VA system, Kaiser, and Geisinger as examples of the successful use of EMRs is disingenuous. These are massive systems with massive budgets and massive around-the-clock onsite IT departments. The vast majority of physicians are not in these megalithic systems. Most of us are in much smaller practices. We have IT departments but the salesmen and software engineers who sold us these magic beans are already down the road looking for the next unsuspecting rube and cannot be reached. Our IT departments are swimming upstream What the federal government can do with a bottomless supply of tax dollars cannot be used to reasonably mandate what happens in small offices constrained by budget limitations. One year ago in private practice I could see eighteen patients per day. A transcriptionist typewrote my notes. These were typically three pages long, concise, complete and extremely useful. Then our group

The Use and Misuse of Information Technology in Health Care: Several Doctors Reply
bought an EMR.
JAMES FALLOWSMAR 24 2014, 5:00 AM ET

One of them writes, "There is a very American tendency to look for technological fixes for significant problems. In general, technological fixes only work in the context of appropriate institutional structures."
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Our new issue has an interview with Dr. David Blumenthal about why it has taken the medical system so long to adopt electronic recordkeeping, and what it will mean when the switch occurs. (Blumenthal led the Obama administration's effort to encourage that change.) On Friday several technology experts and doctors weighed in with responses. Here are a few more. 1) "Give us a cotton gin." Creed Wait, a family-practice doctor in Nebraska does not like the mandated shift to electronic records, at all. [I've added his name, as he sent permission to use it. Also he has moved from Texas to Nebraska.] For now, I am sharing his detailed complaint in full, rather than interspersing comments or "Yes, but" queries: The saying is, “Build a better mousetrap and the world will beat a path to your door. “ The saying is not, “Build a different mousetrap, pay out nineteen billion dollars in incentives to use the mousetrap, mandate its use by

law and punish those who fail to adopt it. Then shove the world kicking and screaming against their will through your door.” So far, doctors have been paid $19B in incentives to buy EMRs [Electronic Medical Record systems]. No one had to incentivize the cotton gin. It was simply a better product. The current EMR system is a mess because the current EMR systems in use by the majority of physicians were written in the Rube Goldberg School of Software Design and work poorly. There is no „asymmetry of benefits‟ as proposed by Dr. Blumenthal. Unless, of course, what he means by this is that only the software companies are benefitting from these federal mandates. Then, I would agree with him. Yes, the benefits are asymmetrical. Build a better mousetrap and we will use it. DVDs came out and they were better than VHS tapes. Overnight the whole world invested in new electronics, we bought DVDs and we threw out our VHS tapes. There was no need for $19B in incentives because DVDs were simply a better product. Flat screen televisions came out and we stopped buying cathode ray tube televisions. Why? Because they were a better product. Laws mandating the use of DVDs and flat screen TVs, bonuses for using them and punishments for failing to do so, were not needed. The market chose the better products. Mandated EMR adoption requires carrots and sticks consisting of trying to implement and maintain software that they do not understand while mandated changes to this software are being released before we can get the last update debugged and working. The doctors are always screaming because the systems are down, we can‟t work until the system is running and the IT guys have the harried and glazed look of caged prey. For the federal government to mandate the use of EMRs by every physician out there just because it works at the VA would be like telling the entire world, “OK, we made it to the moon. Now it is your turn. Any country that has not put a man on the moon within the next five years will be bombed. Every country that complies with this What

the federal government can do with a bottomless supply of tax dollars cannot be used to reasonably mandate what happens in small offices constrained by budget limitations. One year ago in private practice I could see eighteen patients per day. A transcriptionist typewrote my notes. These were typically three pages long, concise, complete and extremely useful. Then our group

The Use and Misuse of Information Technology in Health Care: Several Doctors Reply
bought an EMR.
JAMES FALLOWSMAR 24 2014, 5:00 AM ET

One of them writes, "There is a very American tendency to look for technological fixes for significant problems. In general, technological fixes only work in the context of appropriate institutional structures."
inShare 54

More

Wikipedia image

Our new issue has an interview with Dr. David Blumenthal about why it has taken the medical system so long to adopt electronic recordkeeping, and what it will mean when the switch occurs. (Blumenthal led the Obama administration's effort to encourage that change.) On Friday several technology experts and doctors weighed in with responses. Here are a few more. 1) "Give us a cotton gin." Creed Wait, a family-practice doctor in Nebraska does not like the mandated shift to electronic records, at all. [I've added his name, as he sent permission to use it. Also he has moved from Texas to Nebraska.] For now, I am sharing his detailed complaint in full, rather than interspersing comments or "Yes, but" queries: The saying is, “Build a better mousetrap and the world will beat a path to your door. “ The saying is not, “Build a different mousetrap, pay out nineteen billion dollars in incentives to use the mousetrap, mandate its use by

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