Are Government-Mandated Electronic Records Making Health Care More Expensive?
In today's Wall Street Journal, surgeon and Reason contributor Dr. Jeffrey Singer makes the case against the federal government's electronic health records program. Electronic systems distract doctors by requiring them to face screens rather than patients, he argues, resulting in worse bedside manner and more time spent futzing with electronic systems than real human beings. Singer also points to some evidence that they drive up the cost of care:
[A] Deloitte survey also found that three of four physicians think electronic health records "increase costs." There are three reasons. First, physicians can no longer see as many patients as they once did. Doctors must then charge higher prices for the fewer patients they see. This is also true for EHRs' high implementation costs—the second culprit. A November report from the Agency for Healthcare Research and Quality found that the average five-physician primary-care practice would spend $162,000 to implement the system, followed by $85,000 in first-year maintenance costs. Like any business, physicians pass these costs along to their customers—patients.
Then there's the third cause: Small private practices often find it difficult to pay such sums, so they increasingly turn to hospitals for relief. In recent years, hospitals have purchased swaths of independent and physician-owned practices, which accounted for two-thirds of medical practices a decade ago but only half today. Two studies in the Journal of the American Medical Association and one in Health Affairs published in 2014 found that, in the words of the latter, this "vertical integration" leads to "higher hospital prices and spending."
Here's another problem: The systems don't work. Not like they were supposed to, anyway. Electronic health records were supposed to make it easy to transfer records from one provider to another, increasing integration and coordination between providers. In the relatively small, self-contained health systems that have long used these sorts of records, that's how it works.
But not in the systems spurred on by the federal government.
Most current health IT systems are "quite clearly" not interconnected or interoperable, according to a 2013 RAND study looking at the adoption of health IT. "The health IT systems that currently dominate the market are not designed to talk to each other," the study reported. Rather than enable and encourage broad access across multiple provider networks, they end up creating a kind of lock-in to individual provider organizations. Or, as the RAND study puts it, they effectively serve as "'frequent flier cards' intended to enforce brand loyalty to a particular health care system."
Imagine that: The federal government set up rules intended to encourage provider openness and sharing. Instead, those rules make health care more closed and opaque than ever.
