Can Physicians Apply Preventive Medicine Knowledge to EHR?

As physicians, we devote a great deal of effort addressing things that might - not will, but might - happen to patients. The litany is familiar: smoking, drugs, alcohol, immunizations, guns in the home, accident prevention, cardiovascular risk factors, lifestyle issues, etc.

The list is endless; there are almost an infinite number of things that might happen. We call it preventive medicine. The goal is to prevent diseases and injuries before they exert their damaging effects. It's not a new idea. It was Ben Franklin who said: "An ounce of prevention is worth a pound of cure." The problem is that the patients feel fine and find it difficult to understand our concern. Nevertheless, we keep trying to get them to take the risks and the warnings seriously. Why bother?

First of all, we bother because we have studied medicine. We have the knowledge and we understand the underlying theory that allows us to feel confident that the risks are real and that intervention can alter the outcome. Beyond that there are several other reasons to bother:
1. We believe that the risks, although low, are high enough to warrant concern;
2. Society will be better off (as with vaccines) even if the individual gets only minimal benefit; and
3. When something we could have prevented happens, we will blame ourselves and the patients may blame us for not having tried.

How often do efforts at prevention work? Not often enough. People are notoriously resistant to suggestions that they change their behavior.

It's human nature not to worry about unseen hazards. There is no evidence that doctors do any better than the average patient in this regard.

Are there other kinds of unseen risks, not related to disease, about which we could be doing something? One is EHR. If you have been reading these articles, or practically EHR commentary on the web, you should, by now, have a general idea what they are. Some have a theoretical basis while others have been learned in the school of hard knocks. I'm not going to repeat them here because I have described a number of them in the past and will continue to do so in the future. Practically every day, articles appear that discuss the risks, bad results, cost overruns, and disruptions to work flow and productivity that could be avoided by heeding some of the advice that is offered.

There is a collective (but not organized) effort on the part of those with knowledge and experience to make the “patients” - healthcare organizations and practitioners - aware of the risks that they face and to suggest ways in which they might reduce or avoid those risks. So far the “patients” continue to react with disbelief when apprised of the risks. Perhaps the disbelief can be traced to the lure of incentive payments, the feeling that it is no longer possible to deliver healthcare without a certified computer system, the desire to keep up with the times (or the Joneses), and/or the belief that computers can solve problems. It is the rare practitioner or facility that chooses to stop following the pied pipers of EHR and take a seat in the bleachers.

To gain some perspective, it would be worthwhile to read "Is One Company About to Lock Up the Electronic Medical Records Market?"

It's very disturbing. This article describes a major vendor that favors the goal of dominating the market over technical excellence or a concern for the lifetime medical record. (Do they really think that they will still be around 100 years from now and that we will still want whey have to offer?) The vendor has done a superb job of identifying and selling to the customer’s expectations, with the understanding that those expectations rarely emphasize technical factors or the impact on productivity.

A market dominated by a single vendor poses a risk. When the cost of an EHR is astronomical, the customer may become financially unstable. Perhaps most damaging to the future of EHR is the risk that the development of new EHR science and innovative EHR products will be stifled. It would not be the first time that market domination caused problems, if you remember IBM, AT&T and Microsoft. They were all broken up because their market dominance was deemed to be anti-competitive and anti-innovation.

There is a choice: Turmoil now, while your sanity and finances are relatively intact, or turmoil later, when the unthinkable happens and leaves you broke and crazy. I'm raising these issues because I don't want to wind up hating myself for not making an effort.

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