 |
The use of electronic patient records appears to be on the increase. (The Boston Globe/ File 2007) |
Digital medical records push exposes potential side effects
The push for electronic medical records, fueled by $19 billion from the federal stimulus package, seems urgent and clear; such technology will cut costs and save lives, backers say. But a growing body of research illustrates the potential challenges - from getting doctors to use the safety-enhancing features the systems offer, to the patchwork of privacy regulations in different states.
"Attention nationwide will continue to focus on adoption, and needs to focus on adoption," said Dr. Steven Simon, a professor of ambulatory care and prevention at Harvard Medical School. "Close on the heels, we have to turn our efforts to ensuring these systems are robust and have the capabilities that we think will improve safety."
Simon is coauthor of a study on electronic medical record adoption that surveyed Massachusetts doctors in 2005 and 2007. Over that time, he found, electronic medical record adoption jumped to 35 percent of practices, from 23 percent.
But he also found that over the same time, there was little change in the use of many of the system features thought to increase the safety and efficiency of medicine. For example, reminders for tests or appointments - such as mammograms or Pap smears - were not available in all doctor's offices that had electronic medical record systems installed. And when they were available, many doctors reported that they didn't use them, reported the study, to be published in the Journal of the American Medical Informatics Association.
The one exception was the increased use of electronic prescriptions, which were more widely used and available.
Another new study examined how state medical privacy laws affect adoption of electronic medical records.
That work, to be published in the journal Management Science, found a tradeoff between privacy and electronic medical records. When a state has health privacy laws in place, it reduces the likelihood a hospital will adopt an electronic medical record system by 20 to 30 percent, according to coauthor Catherine Tucker, an MIT Sloan School of Management professor.
"What we found is that when we were talking to hospitals, a lot of the costs came because these state laws are very different and so it meant that a vendor couldn't sell a standardized solution," Tucker said. "Any time you mention customization and software, it gets costly."
But even when hospitals and doctors are willing and interested in adopting an electronic medical record system, care must be taken in designing systems that are open and flexible, said Dr. Kenneth D. Mandl of Children's Hospital Boston.
He gave an example of the power of electronic medical records to provide a check on safety through his own work. Mandl examined data that were being collected through the Partners Healthcare System between 1997 and 2006, and found an increase in heart attacks eight months after the introduction of Vioxx, a drug that was withdrawn from the market in 2004 because of risk of heart attack or stroke. The peak subsided a month after the drug was withdrawn, the study found.
The idea, Mandl says, is not only to collect data, but to have systems that are sensitive to trends and can identify them in real time.
But perhaps most important, he said, is that the technology not waste the valuable time of people who provide healthcare.
"We should be thinking very specifically about what we want to accomplish when we take a physician's time to sit in front of a computer, or a nurse's time instead of being with a patient," Mandl said.
"I think we really want to account for the value of every second that they spend in that activity, because it clearly takes them away from another activity, which is talking, communication, teaching, diagnosis."
Carolyn Y. Johnson can be reached at cjohnson@globe.com. 
© Copyright 2009 Globe Newspaper Company.
