Star Tribune illustrates how health reform myth becomes “fact”
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Yesterday’s Minneapolis Star Tribune published an article praising electronic medical records (Thomas Lee, “A sort of ‘Turbo Tax’ for doctors,” March 23, 2009, D1). The article illustrates how corporate propaganda — in this case, the claim promoted by the computer industry that electronic medical records save money – becomes accepted “fact” among the nation’s reporters and politicians.
The research on the impact of electronic medical records (EMRs) on quality is mixed — some studies show EMRs improve quality, others show EMRs have no impact on quality, and others indicate EMRs damage quality. Given the mixed evidence on the impact of EMRs on quality, it is no surprise that there is no credible evidence that EMRs can cut health care costs. But the mainstream media and the Star Tribune do not pass this information on to their readers.
The Star Tribune article began with an anecdote about a Bloomington surgeon that illustrated a statement that is almost certainly true – that EMRs can improve the speed and accuracy with which doctors fill out claim forms for insurance companies. But then the article veered off into hype — hype that wasn’t obvious to readers. The article leaped from an illustration of how EMRs can help doctors submit bills faster to the much broader claim that electronic medical records (which cost about $40,000 per doctor to buy and install, and $5,000 to $10,000 per doctor per year to maintain) save money. The article stated:
[A] study by the RAND Corp., a think tank based in Washington, DC… estimates that EMR [sic] could save more than $77 billion … a year by reducing patients’ length of stay and the amount of time doctors and nurses devote to administrative tasks such as billing and updatng patient records.
The RAND study has been cited hundreds of times since it was published in 2005 in Health Affairs (Richard Hillestad et al., “Can electronic medical record systems transform health care? Potential health benefits, savings, and costs,” Health Affairs 2005;1103-1117). This “study” was cited by the websites of Hillary Clinton and Barack Obama during their campaigns for the presidency, for example.
But this “study” is junk science.
The first thing you need to know about it is that it was financed by the computer industry. You can see the names of the companies that financed this study at the end of the Health Affairs article (they were Hewlett-Packard, GE, Cerner, Johnson and Johnson, and Xerox).
Second, the “study” was roundly criticized by three articles published in the same edition of Health Affairs.
Third, the $77 .8 billion dollar savings predicted by the RAND scholars (don’t ask me why Hillary Clinton and the Star Tribune rounded down to $77 billion) will not materialize until 2019, at which time it will amount to a grand total of 1.6% of total health care spending, according to one of the three papers critical of the RAND paper published in the same edition of Health Affairs (Clifford Goodman, “Do it for the quality,” 1125).
Fourth, this magnificent savings of 1.6% that we will allegedly realize a decade from now was based on an absurd assumption. The authors decided they would exclude from consideration any published research which found that EMRs had a negative impact on patients. Why? Because they decided such an outcome had to be the fault of the people who used the EMR, not of the EMR. Here is how the RAND authors expressed this assumption: “We chose to interpret reported evidence of negative or no effect of HIT [health information technology, a phrase that incorporates EMRs and a few other medical uses of computers] as likely being attributable to ineffective or not-yet-effective implementation.” This should remind you of the National Rifle Association’s mantra: “Guns don’t kill people, people kill people.”
The Congressional Budget Office, the nonpartisan research arm of Congress, rejected the RAND paper in its May 2008 report on EMRs (Evidence on the Costs and Benefits of Health Information Technology, http://www.cbo.gov/doc.cfm?index=9168). It did so for several reasons, including the RAND authors’ absurd belief that papers that report negative effects of EMRs can be ignored.
The CBO reviewed all of the claims made for EMRs by the RAND paper and by other advocates of EMRs, including:
(1) EMRs reduce the cost of pulling paper charts;
(2) EMRS reduce the number of tests because they alert doctors when tests have previously been ordered;
(3) EMRs cut prescription drug costs by (a) inducing doctors to order more generics and (b) by reducing the number of adverse drug reactions;
(4) EMRs make it easier to create patient medical records and in other ways improve the productivity of doctors and nurses;
(5) EMRs cut the average length of stay in hospitals because EMRs permit faster ordering and administration of tests and faster printing of discharge instructions;
(6) EMRs cause doctors to adhere to guidelines more often;
(7) EMRs, when they are adopted by all clinics and hospitals, will create a virtual national medical records database, and this in turn will permit researchers to discover cures and better treatments for less than the cost of traditional biomedical research.
CBO concluded that research supported only the first claim — that EMRs reduce the cost of retrieving records. CBO said research on the other claims was either nonexistent or mixed.
But despite the criticism of the RAND paper by the CBO and other experts, politicians and reporters continue to endorse the computer industry mantra that EMRs save money, and they continue to site the RAND paper as evidence for the mantra.
Kip Sullivan