Doctors and Computers

In Australia, 8 of every 10 doctors keep patient records electronically.  In New Zealand and Britain, the figure is 9 in 10.  In the Netherlands, almost every doctor uses electronic medical records (EMRs).  Yet in the US, the figure is less than 1 in 4.  Only Canada scores worse.  So says a recent Commonwealth Foundation report. (Click here to read.)

It gets worse.  In other countries doctors are more likely to be able to order prescriptions electronically, to get computerized alerts about potentially harmful drug interactions, and to get computerized prompts to send patients test results or notices about preventive or follow-up care.

So why are US doctors falling behind?  The short answer is because doctors in other countries get financial rewards for using computers and our doctors don't.  But why are other country's reward systems better?

In some press reports, the words "centralized" and "public" are contrasted with US system descriptors: "decentralized" and "private."  Centralization clearly changes incentives.  Since the VA system and Kaiser are directly responsible for all patient health care costs, they gain more from information technology than independent hospitals, private practice physicians and garden variety private insurers.

But if socialism were the answer, why does Canada (the ideal for single-payer advocates) score worse than we do?  Also, in its summaries and press releases, Commonwealth cherry picks its results.  Over all measures, the UK comes out on top for the use of computerized systems (probably owing to the 50% increase in the NHS budget under Tony Blair).  But British doctors are as likely as US doctors to have to repeat a test or procedure because the findings are unavailable or to discover the patient's medical records are unavailable at the time of a patient visit. 

Even with their computerized systems, British doctors are three times more likely than US doctors to experience problems because care is not well coordinated across multiple sites or specialties.  Also, British patients are 6 times as likely as US patients to experience long waits for diagnostic tests and 7 times more likely to experience long waits for surgery.  (On waiting times, patients in most of the other countries also fare much worse than US patients.)

Long before doctors in any of these countries were using computers, lawyers had all their client records stored electronically.  Ditto for accountants.  And engineers.  And architects.  And virtually every other professional.

We don't need socialism to bring doctors into the 21st century.  We need markets.   

Read the full article here.

Comments (6)

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  1. Anonymous says:

    To add to your point, there is evidence that the imposition of IT systems on complex system increases risk. Ross et al. JAMA 2005;March 9 show that computerized order entry systems introduce new kinds of medication errors. Han et al. Pediatrics 2005; Dec recorded an increase in mortality after a commercially sold computerized physician order entry program was installed in their tertiary care children’s hospital. In the 18 months after its installation, mortality rate appeared to increase from 3.8 percent to 6.57 percent. Unexpected problems include the fact that microbes colonize keyboards and mice. Proper infection control requires daily disinfection.

  2. Anonymous says:

    Having worked on the development of the Duke Cardiovascular Database in the 1960s I feel somewhat qualified to comment on the use of computers in medicine. Computers are best used for prognosis in chronic disease. That means rigorous definitions and agreed usage of terms across all practice groups, that is near impossible to achieve even in one instituion like Duke University Medical Center. The problem is not the technology. The problems are political — human being problems. “Markets” won’t solve this problem. The electronic medical record is related to prognosis in that we made an electronic medical record where critical pronostic factors were stored and searchable. Today’s electronic medical record ( and we use one in our group cardiology prctice) are not easily searchable and do not look at outcomes in a way that links practice to outcomes. So, the stored material is helpful but really not worth the money. And the records are not portable or easily transferrable between or among institutions. All that is technically doable but it is a big political problem and expensive. Markets do not solve those political problems. Why don’t we have a Duke like database in practice linked to a medical record? Insurors and government entities don’t want to pay for them. I guess the market does speak. Don’t blame U.S. doctors for this. Blame the payors. Doctors are poorly reimbursed by HMOs and Medicare. Increasing overhead to buy an elctronic medical record is not feasible in most U.S. practices. And the analogy to law is not correct. As a practing lawyer, I love the Westlaw and Lexis databases. But clients get billed for these services. The reason we don’t have great searchable databases in medicine like we have in law is that patients don’t want to and will not pay for information and data storage services. HMOs and politicians who promote HMOs –especially conservative Republicans – have taught them over the years that medical care is “free.” The real use of
    computers in medicine is to harness technology to help doctors make decisions about a current patient based on how various therapies resulted in specific outcomes. Eg a diabetic female patient with chest pain: is bypass vs medicine vs stent vs drug eluting stent the best way to go and at what cost. Setting up a computerized system that does that is a complex problem that is largely political. Medicine – doctors and payors and governemnt entiteis – have understood the value of this approach for over 40 years but don’t have the political will to do it. Writing patient records in computers is easy to do but won’t solve the big problems that will lead to more rational allocation of scarce resources.

    Brant S. Mittler MD JD
    San Antonio, Texas

  3. Rick Maciorowski says:

    My own solution as a type one diabetic is to insist that all my medical practitioners give me whatever they have (images from tests and notes) on a CD. I then transfer them to a jump drive I carry around my neck with a directive on my medical bracelet that all known records are on my jump drive and to phone my wife for the password. A very secure portable "network," the jump drive (2 Meg ) costs $19.00 and can be plugged into any office USB port. Why must we wait 10 years and spend billions of dollars to achieve availability of a patient’s medical records?! This was one of my suggestions in my recent MBA thesis on the US health care system, along with many examples of how we (the consumer) can bring about change. Michael Porter emphasizes that most, if not all, the competition is acting inappropriately in improving access and cost of our health care system. We operate in a global environment and try to complete in one at approx 17% or our countries GDP Health care is the last area where we MUST incorporate competition. With out doing so we will ultimately cost the US out of the world economy. Rick Maciorowski DBA (Informix) Systems Administrator HP/UX, Baan Development and Systems Administration, Baan Email Administrator Legacy System Support and Development, EDI Administrator

  4. Bob says:

    One very important reason that so few have their patients on electronic medical records is that there is not one standard form, which countries with a universal system can provide. And all of us have been burned by installing expensive software programs that were flawed and had to be deep 6xd. Also those countries don't have the numerous billing situations, the appeal and denial process which eats up time better spent and the staff necessary to do the "paper"work. If one thing could be implemented I would suggest a competition where all the software folks submit their best effort and choose one. To permit free market competition, have different programs for the different specialties, which give the marketplace the chance to gain traction and provide the service. And I think the number is more like only 1 in 6 who have EMR's for their patients. Bob

  5. […] My recent article, published online by Health Affairs, explains all these problems are a direct result of the way doctors are paid.  […]

  6. Donald says:

    Donald I just wanted to write to say that you have a great site and a wonderful resource for all to share.