Over-promising on the benefits of electronic medical records

Two doctors who are also on the faculty of Harvard Medical School have a column today pointing out that President Obama is over-promising on cost savings of $80 billion by implementing electronic medical record keeping. The claims for all that savings come from one RAND report that hasn't been supported by other studies.

The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

There also seems to be some counter evidence demonstrating that there won't be a big financial windfall from implementing such electronic records.

Where do the RAND policy analysts posit major cost-savings? They imagine that the computer will guide doctors to deliver higher quality care, and that patients will better adhere to quality recommendations embedded in the computer programs. This would apply to both preventive interventions like vaccines and weight reduction, and to therapy of costly chronic maladies like diabetes and congestive heart failure. Over 15 years, the RAND analysts assert, more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care. Unfortunately, data to support such an appealing scenario are lacking.

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems." Similarly, researchers from the Brigham and Women's Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, "As implemented, electronic health records were not associated with better quality ambulatory care." And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, "should be of concern to adopters, payers, and jurisdictions."

Electronic medical records may well facilitate the doctors' jobs and ease record keeping and insurance claims. But don't try to sell them as a cost-saving device or overpromise on how there will be these magnificent health benefits for everyone. If Obama is truly interested in supporting only those reforms that have substantial research supporting the costs and benefits, then he may need to research his proposal a bit more.