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A Pound of Cure

Good piece in the Technology Review about resistance to implementing electronic medial records by the medical industry. His main points call out the fundamental misalignment of incentives, which reward treatment volume rather than quality of care or prevention:

The reason lies neither with cost nor with inadequate technology. Rather, the health-care industry's reluctance to digitize its records is rooted in a desire to keep medicine's lucrative business model hidden. Dangling $19 billion in front of a $2.4 trillion industry is not nearly enough to get it to reveal the financial secrets that electronic health records are likely to uncover--and upon which its huge profits depend. In those medical records lie the ugly truth about the business of medicine: sickness is profitable. The greater the number of treatments, procedures, and hospital stays, the larger the profit. There is little incentive for doctors and hospitals to identify or reduce wasteful spending in medicine.


and

The Congressional Budget Office then suggested that $700 billion of the approximately $2.3 trillion spent on health care in 2008 was wasted on treatments that did not improve health outcomes.

That's an f*ing large number. A fairly new angle for me was his call that EMRs will enable data mining & analysis and longitudinal studies on a scale still impossible today. It's a pretty fascinating and hopefully important idea, though there's no discussion of the new data silos that will result or the coming fights over privacy, ownership of patient data, and access to that data.

And, finally, a point that doesn't come up until the comments - it's hard to get patient data into EMRs in the first place. Doctors aren't used to it and most of them don't want to learn. Changing human behavior is hard, and the massive friction added to the exchange by deeply shitty user interfaces. It's going to take careful human-centered design not just of the EMR software itself, but of the hardware interfaces and, particularly, the organizational behavior and processes that surround it - the people matter.

via Jay Parkinson + MD + MPH. If you're interested in health care you should read his stuff.