Two articles caught my attention this week amid of the flurry of news about jobs, the market and the economy. The first, Not retiring at 65: Physician goes from anti-EHR to pro-ACO, was about a 65 year old physician in Tucson who is not only delaying retirement, but has moved from a rather negative position on electronic medical records to one that is quite favorable. The other article is an excellent piece by health futurist, David Ellis, and three physician colleagues that appears in Hospitals and Health Networks Online Daily. The Lure of New Devices in the OR explores how expensive and sometimes wasteful technology finds its way into the operating room.
Considering the havoc in the markets of late, I guess I’m not surprised to see physicians delaying retirement. Then again, it is probably good news if more physicians decide to stay the course and keep working. Perhaps it will help diminish some of the dire physician shortages that are being predicted in coming years especially in primary care. It is also encouraging to see older physicians coming to the realization that electronic medical records do add value in patient care, even if the initial expense and learning curve may at first seem daunting. New physicians coming out of training who are the so-called “digital natives” couldn’t imagine using paper records to care for their patients. Furthermore, most physicians who’ve taken the EMR plunge, even if it has been painful, say they would never go back to paper. So for all those physicians who are still holding back, it seems the time has come to either go with the flow or perhaps do what the physician in Tucson decided not to do – retire. And whether or not you believe that “Accountable Care Organizations” will be the norm in the future, electronic records will prove invaluable in helping us measure and analyze the quality and outcomes of what we do in our practices. Digital data will also help us measure deficiencies in population health and guide us in strategies to improve the health of all citizens. One only needs to look at how Kaiser Permanente has exceeded quality and satisfaction measures for just about everything they do to understand how electronic health records can transform medical practice.
Of course technology isn’t a panacea. As David Ellis and his colleagues point out, when it is used indiscriminately or as a marketing ploy as it is too often in the operating room, it is just wasteful and sometimes harmful. It is all too easy to demand the latest new technology when neither the surgeon nor the patient is directly connected to its cost. The clinician doesn’t care if he or she isn’t paying for the equipment. The patient doesn’t care because he isn’t paying directly for it either and frankly may be swayed by the fact that his doctor is using the “very latest technology”.
Whether buying the most advanced electronic medical record solution or the newest gadget for the operating room, we must more consistently look at the value it brings. Value considers both the cost of something as well as its worth. Is the technology worth the cost? Furthermore, does it improve quality? Higher cost may be justified if outcomes are significantly improved. We all grapple with making these tradeoffs in everything else we buy. Why is it that we struggle so in healthcare?
This is the beginning of a new era in health information technology. Cloud solutions will significantly bend down the cost curve especially for so-called commodity IT workflows like messaging, e-mail, voice and video communication, and solutions for collaboration and data analytics. Lower costs and better technology will bring greater value to clinicians, administrators, patients and citizens everywhere.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft