Five Misconceptions About e-Health Records

The other day I was visiting with a family friend, a retired pediatrician, and got to talking about the Wide Angle this week, which focuses on electronic health records. The retired doctor is completely against the switch and gave me some reasons why. I thought they sounded reasonable. But what do I know about being a doctor and converting my office to a computerized format?

So I posed the concerns to Jay Wolfson, a professor of public health and medicine and the associate vice president for health law, policy and safety at the University of South Florida in Tampa. He is a leader in Florida's attempt to develop an electronic health network. Here are his responses to some of the reasons my doctor friend -- and most likely other people -- have for not making the switch to electronic records.

REASON NO. 1 NOT TO SWITCH: Electronic health records won't save money. The switch is costly, and the computer hardware and software upgrades inevitably required in the future will add cost to this investment.

WOLFSON: Electronic health records alone may not save money, certainly in the short term, but their use will save money and lives. Consider the number of medical tests that are re-performed because the paper records are misplaced or sent to the wrong address; and the number of times patients must personally go to the radiology lab and pick up a hard copy of an X-ray, CT scan or an MRI and then hand-carry it to the consulting physician's office. Consider also that most physicians' medical records are
handwritten in mostly illegible script, making it impossible for anybody else to know what really happened to the patient.

There is more. The paper system of medical records makes it impossible to coordinate care between providers without physically sending cumbersome, often illegible and non-standardized copies of documents from one physician or hospital to another. Health care, as a high-tech service industry, is in the dark ages with respect to the use of modern information technology. And the result is that we are jeopardizing the quality and safety of services provided to people and adding the burdens of inefficiency to the cost of health care.

Yes, there are start-up costs, just as there are when any industry goes through a sea change to improve quality and efficiency. But the result will be improved quality, access, safety and, as a consequence, improved efficiencies and lower costs.


REASON NO. 2 NOT TO SWITCH: Putting a doctor behind a laptop reduces the personal relationship between doctor and patient.

WOLFSON: There is no evidence to indicate this occurs.  Depending on the type of practice (pediatric, adult, generalist, specialist, medical or surgical), the use of the technology to retrieve or input data can be scaled and designed to fit the culture of the practice and the personal proclivities of the clinician. It should be no different than taking written notes, and will be far more reliable and efficient.

REASON NO. 3 NOT TO SWITCH: Files won't be safe. Hard drives fail and data can be lost in an instant. And if a system goes down, the doctor's office will have to cancel appointments.

WOLFSON: Electronic health information systems are built upon the same platforms and system requirements that are used by the banking industry and the military. There are multiple back-up systems in remote locations. This includes, in most instances, local back-ups for system downtimes that permit paper alternatives. 

REASON NO. 4 NOT TO SWITCH: Data can be hacked, and personal information can be used in illegal ways that can ultimately undermine the patient's privacy and, worse, their health care.

WOLFSON: Security systems associated with electronic health information are predicated on the same access-protection measures used in banking and the military. Paper records are more accessible. The concern about information getting into the wrong hands has always been an issue and has resulted in federal and state laws, including HIPAA [Health Insurance Portability and Accountability Act]. The number of people relying upon electronic banking is huge and growing each day in terms of deposits and bill paying. Use of ATM machines and even purchasing books and other items on the Internet has become a common and accepted part of personal financial transactions. It is true that there is no perfect system, and security and confidentiality are and must remain the paramount factors driving the design and use of any product.

REASON NO. 5 NOT TO SWITCH: Having the information in electronic form doesn't make it any easier to transfer between doctor and specialist. This is easily done by fax.

WOLFSON: Incorrect. It makes it easier if the data are in fairly standardized formats and can be easily called up on a screen by the clinician. It makes the information easier to read (rather than having to interpret somebody else's faxed handwriting) and easier to share instantly. Faxing may be useful for a few single pages, but not for complex, technical medical records and charts.

Wolfson also wrote:

There is no quick fix or silver bullet. The ailments afflicting our health care system are chronic, not acute --- and while there are legitimate concerns about the immediate costs, the fact is that the train has left the station. Medical students are being trained now to be paperless, and the liabilities and risks associated with not having fuller access to timely, accurate, reliable medical information about patients, along with the imperative of being able to more effectively monitor and measure quality, outcome and safety, mean that electronic health records will become a normal, common part of the health care delivery system starting at the clinical level.

It will be at least a decade before the health care system adapts to a digital format throughout --- but we have an obligation as health and medical care leaders to recognize the value of e-health records and to help encourage our colleagues, students, patients and policymakers to understand that value in terms of improved outcomes, quality, costs and access in the longer term.

The stakes here are literally life and death, and there is too much technical, complex and time-sensitive information in today's health care system not to recognize that electronic health records are a natural part of the evolution of medicine and health care. It means change, which many people find difficult. And that is understandable.  But quality, safety and the ability to measure and better manage are things that patients and their families and physicians and hospitals, and payors (employers and governments -- that would be you and I as tax payers) deserve and should demand.