The Mouse Is Mightier, or Is It?

The attitude these days seems to be that relying on computers instead of people will fix everything. So it may come as a surprise when the New York Times ran an article last month entitled, "Little Benefit Seen, So Far, in Electronic Patient Records."¹ It shouldn't.

The current trend toward computerization of hospitals actually suffers from a serious problem: ignoring those who actually use this software. Merely giving people technology to do what they did before won't improve medical care, unless it opens up new ways of practicing medicine.

The big issue computerization seeks to fix is wasted time: time spent looking through records, gathering film from radiology departments, or tracking down patients instead of delivering care. With digitized medical records and the Internet, doctors now should be able to put more of that time into seeing patients and providing better care, right? Wrong.

In the highlighted study, the authors examined over 3,000 hospitals in three groups — full, basic, or no electronic health records — and then examined the performance of physicians and hospitals as a whole. The average patient stay in hospitals with full digital records was 5.5 days versus 5.7 days for basic or no digital records. Best practice standards in heart failure were similarly close among the three groups: full 87.7%, basic 86.7%, and none 85.9%. While there seems to be small improvement with electronic patient records, this may very well be within the margin of error for the data.

So why isn't computerization helping doctors provide better care? Simple: it's not changing anything about the way doctors practice medicine. Time that used to be spent writing and going over paper records is now spent figuring out how to make this new software do what doctors used to do on paper.

Electronic patient records, the first line of computerization, won't improve patient care without a paradigm shift. Furthermore, the current evidence for the "promise of medical records" is biased.

According to Dr. Ashish K. Jha, the lead researcher on the study, the significant improvements come from "an elite group of large, high-performing health providers that have spent years adapting their practices to the technology." Or adapting the technology to their practices, working with Microsoft HealthVault and other electronic record developers as in the case of the Mayo Clinic.²

The hospitals with the most improved care had both significant attention paid to them by the developers in understanding what the products could do as well as more input into making sure that this included features that existed within the old paper-based system.

Now that the product has been designed, both training and feedback ability may exist to a much more limited degree for other hospitals attempting to use the software. If these hospitals hope to reap the same benefits as the Mayo Clinic, they will need to invest much more into training and customization. Ultimately, this means that for the rest of the nation's hospitals making electronic patient records useful will need the very thing this technology is trying to free up: time.