RAND: EHRs Are Not Saving Money

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

More on the unmet expectations for electronic health records in the NYT.

Comments (8)

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  1. Studebaker says:

    EHRs are not unlike any other information system. I doubt offices would be able to accurately estimate the productivity gains of using Microsoft Office if asked to do so. If 30 years ago bureaucrats decided all offices should use Microsoft Office, but office had identified a need for the system, the implementation would have not gone smoothly either. Only when the information systems service a specific need that enhances the hospitals’ business model will they successfully integrate these systems. Moreover, the software design might not be anything like its current state if hospitals chose them voluntarily. This is largely an exercise in futility!

  2. Neil Caffrey says:

    Electronic records could potentially save a lot of money. However, I believe that there has been a failure to implement succesful changes.

  3. Jeremy says:

    I agree with the comment above. I believe that there is a lot of potential for this system to work if used properly. However, the lack of compliance we have already heard coming from several physicians and perhaps the inability for certain health providers to adjust to EHRs may be becoming an issue for this new technology to function efficiently.

  4. Dr. James Franco says:

    This is certainly becoming an issue that is increasing in importance. More study is needed on the matter.

  5. Sebastian Alexander says:

    The RAND article does not challenge the biases of the Health IT cult. For example: “interoperability” – that Health IT should facilitate providers’ communicating with each other.

    The article describes the productivity improvements in retail, much of which is driven by IT. But Macy’s IT systems are not interoperable with Nordstroms’ IT systems.

    And yet, they have improved productivity. There’s no reason to think that competing health systems should have interoperable IT systems in order to achieve productivity improvements.

    This blog has already noted that health IT has sometimes allowed providers to “upcode” better, thereby increasing costs. So, third-party payers are always going to impose friction on the billing system, no matter how efficient the IT is.

    Also, as a patient, I’m not sure I want all the providers to know what each other know. If seeking a second opinion, I don’t want the second specialist to know what the first diagnosed. That would not be scientific!

    If EHRs lead to everyone following the same mistaken first diagnosis, that is hardly useful.

  6. Mulligan says:

    Unfortunately I don’t have access to the full article, but the abstract mentions Health IT and not specifically EHRs. The systems don’t have to be the same in order to utilize the same EHR.

  7. Sebastian Alexander says:

    The article addresses Health IT “writ large”, i.e. all aspects. No: the systems do not have to be the same in order to use the same EHR. But we’ve got almost half a century of experience integrating IT (in all environments) to know it costs much more and is more trouble than the vendors and consultants tell us.

    If the patient controls the EHR, I suppose he can force interoperability onto providers’ systems. For example, I keep the records of my Toyota 4-Runner’s maintenance (on paper) so I can show them to any garage – either the dealer or (if I choose) the Japanese auto shop that is not certified by Toyota. But those two providers will not share information with each other.

    Consumer-driven EHRS are quite useless, which is why Google Health shut down. Marathon runners, for example, will keep overly detailed records of their pulse, weight, carb intake, et cetera. But sick people will not maintain meaningful health records.

    So we have a dilemma to which there is no real answer, no matter how much federal money is thrown at it.

  8. James R Chaillet, Jr. ,MD says:

    As a physician currently using 3 different EHRs (yes, I work a lot of jobs) and having used a couple of others over the years I like to make a few observations.
    1. Those implementing the EHRs (usually, not MDs) neither try to integrate EHRs into a reasonable efficient workflow based on paper charts not do they re engineer workflows to take advantage of what EHRs can offer- more complete date collection, decision support, easier retrieval of data,etc.
    2. In a fee for service world, productivity equals production; in a prior world called capitation, a long time ago, productivity could include reduced costs and better clinical outcomes. EHRs, plunked down into a practice decrease productivity.
    3. The not so secret dirty secret about why a lot of organizations implemented EHRs( before the government incentives) was the ability to “upcode” legitimately.
    A few keystrokes or clicks of a mouse and a level 3 visit becomes a level 4 – sometimes legitimately,sometimes questionably
    4. Finally, I’ve not seen so much written crap generated as with EHRs. I request an ER report and get 9 pages of junk and page of useful information. (clinical)