Health Care Technology Not Quite There Yet

No one is doubting the potential of health information technology, including electronic medical records, to enhance patient care. Progress, however, is needed in many areas, according to a senior researcher with the Center for Studying Health System Change. The New England Journal of Medicine reports:

Health information technology (HIT) holds promise for facilitating vast improvements in care and, ultimately, in the health of Americans,1,2 but achieving that potential remains a daunting task. A recent article in the Los Angeles Times described the new phenomenon of hiring computer-savvy undergraduate “scribes” to take notes for physicians during patient encounters and enter the information into electronic health records (EHRs) — a practice that suggests how far we must go to develop EHRs that clinicians will embrace. Of course, the most highly trained professional in the room need not be the one to enter data into the computer, especially during an emergency, but the perceived need for scribes and providers’ experiences using EHRs3 raise important questions about both the efficiency of care processes and the usability of current EHRs.

Although EHRs laudably provide immediate access to patient data and electronic messaging functions, clinicians have been frustrated by the difficulty of using them to support care delivery and coordination.3 Transforming EHRs into effective clinical tools rather than a means of capturing information primarily for documentation and billing purposes will require progress on multiple fronts.

Clinical processes must evolve so as to improve care and be more responsive to patients’ needs, and HIT’s capabilities must evolve along with them. HIT has particular potential in such areas as coordination of care, workflow efficiency and use of teams, clinical decision support, and population health management — all areas offering glimpses of both the potential and the challenges associated with improved HIT use.

Few providers today, for example, can truly coordinate care — integrating care, in consultation with patients and their relatives and caregivers, across all of a patient’s conditions, needs, clinicians, and health care settings.2-4 Outpatient practices and inpatient facilities lack well-developed processes for exchanging information, both within their own walls and during care transitions. Poor care coordination negatively affects patients — particularly those with multiple chronic conditions who account for an overwhelming proportion of U.S. health care expenditures.

Laws Don’t Alleviate Doctor Fears

Fact: Doctors are worried about malpractice lawsuits.

Analysis: Such worries can increase actions that drive up health care costs. And a new study says that caps on economic damages are often not enough by themselves to take care of the problem. Health System Change reports:

Even in states with economic damage caps in malpractice suits, physicians remain highly concerned about being sued, suggesting that many popular tort reform proposals may do little to deter the practice of defensive medicine that contributes to unnecessary health spending, according to a study by researchers at the Center for Studying Health System Change (HSC) in the September Health Affairs.

“Our results suggest that many popular tort reforms are only modestly associated with the level of physicians’ malpractice concern and their practice of defensive medicine. The results raise the possibility that physicians’ level of concern reflects a common tendency to overestimate the likelihood of ‘dread risks’—rare but devastating outcomes—not an accurate assessment of actual risk,” according to the article.

“Whether justified or not, physicians’ liability fears are a policy problem because defensive medicine raises health care costs and potentially subjects patients to unnecessary care,” said Emily R. Carrier, M.D., senior HSC researcher and coauthor of the study with James D. Reschovsky, Ph.D., senior HSC researcher; Michelle M. Mello, Ph.D., J.D., a professor at the Harvard School of Public Health; Ralph C. Mayrell, a former HSC health research assistant; and David Katz, M.D., an associate professor at the University of Iowa.

The authors point to recently funded demonstration projects to test new approaches to liability reform, including alternatives to litigation that emphasize early disclosure and settlement of claims through less adversarial processes, as a way to address physicians’ liability concerns more effectively.

The Health Affairs article, titled “Physicians’ Fears of Malpractice Lawsuits Are Not Assuaged By Tort Reform,” is based on findings from HSC’s 2008 Health Tracking Physician Survey, which is sponsored by the Robert Wood Johnson Foundation, which also funded the study. The survey includes responses from 4,720 physicians who provide at least 20 hours per week of direct patient care and had a 62 percent response rate.

The survey asked physicians to indicate how strongly they agreed with the following statements based on a five-point scale, ranging from “strongly disagree” to “strongly agree:” (1) I am concerned that I will be involved in a malpractice case sometime in the next ten years. (2) I feel pressured in my day-to-day practice by the threat of malpractice litigation. (3) I order some tests or consultations simply to avoid the appearance of malpractice. (4) Sometimes I ask for consultant opinions primarily to reduce my risk of getting sued. (5) Relying on clinical judgment rather than on technology to make a diagnosis is becoming risky because of the threat of malpractice suits.

Between 60 percent and 78 percent of all physicians agreed or strongly agreed with each of the five statements related to malpractice concerns. Physicians agreed most strongly with the statement that it is becoming increasingly risky to rely on clinical judgment rather than diagnostic testing, with 78 percent either agreeing or strongly agreeing.