Medical experts were shocked earlier this week when a new RAND study on electronic medical records found that the new technology has been much less successful in reducing health care costs than everyone originally predicted. But the RAND data tells part of the story, as another recent study published in the journal Health Affairs shows:
The relationship between a physician practice’s adoption of electronic health records (EHR) and quality improvements in patient care remains unclear. However, a new study published in the January issue of Health Affairs by Weill Cornell Medical College and the Primary Care Information Project (PCIP) of the New York City Health Department shows evidence that EHR implementation can improve patient care in small physician practices in New York City when combined with sustained high-intensity technical assistance.
Using accepted benchmarks for improved quality care, the study found that when EHR was combined with training, physicians were in fact able to improve the care they offered their patients.
Both studies are probably right. Improving health care outcomes is not the same thing as reducing health care costs. The trouble is that America needs both: we need better outcomes at lower costs and, so far, electronic records haven’t done the job.
As we argued when RAND’s study was released, the lesson isn’t that the use of modern IT in healthcare has failed, but that massive government programs are extremely poor at putting this technology to good use. The health care system is simply too complex to be capably run by even the most skilled bureaucrats. Regulations have unintended side effects and perverse consequences; powerful interest groups dominate the regulation writing process. And no top down administrative fiats can replace market mechanisms for providing both consumers and producers with vital information which can lead them to adopt better practices.
This doesn’t mean that the technology itself is useless—indeed, using IT and big data to streamline the delivery of medicine is one of the most promising avenues for decreasing the cost and improving the efficiency of healthcare. But for technology to do its job, the regulatory framework and incentive structures have to be right; currently they aren’t, and this dramatically reduces our ability to make health care better and more affordable.