Briefly, Back to the EMR--Another Market Failure?

No, I promise, this is not going to stop being a blog about medicine and the pharmaceutical industry, and turn into a blog on electronic medical records. But just one more brief comment on the latter topic that I really think ties indirectly to many of the issues we discuss here.

Thanks again to Roy Poses' blog for linking this neat article:

http://www.boston.com/news/health/articles/2009/05/04/few_hospitals_go_paperless_using_free_va_software/

The gist: Many years ago the VA system built its own electronic medical record. At the same time as this was happening, the VA was shedding its old image as the armpit of US health care and zooming to the top of the charts as the new quality leader. Many credit the medical record system with being at least a part of this revolution. Being a government agency, the VA made its record with open source software. Anyone and her duck can download it and set up her own system using that software, called VistA. (You still have to buy the computers and the time of the technical staff to run the thing of course.)

Since most VA patients are part of the VA system, the VA seldom bills insurers or other government programs for care, so billing is really not part of VistA. But experts say that it is pretty simple to tack on the billing function.

The Globe article shows that the state of West Virginia has recently had great success in converting all of its state-run hospitals and nursing homes to electronic records using VistA, and saved a ton compared to the cost of commercial EMR.

According to my theory of how the EMR has turned sour in many cases after its initial success and promise, VistA should be an excellent system to adopt, much better than many of the new EMRs sold off the shelf to gullible hospitals and offices. It was built from the ground up and extensively debugged by zealots who really believed in the EMR concept and who knew that all VA docs would eventually have to buy into the program. Thye knew that making it user-friendly would have to be a big part of the job. To the extent that its EMR helped the VA achieve its current high quality standing, it is also a proven product.

So given that it is out there for free, you'd expect it would be widely used, right? And you'd expect that commercial folks would see the potential in tech support companies that would take VistA and adapt it to your special needs, right? (Flexibility and adaptability are features, experts say, that were built into VistA.)

Well, no. The Globe article shows that there has been minimal take-up of VistA and that there is still only one relatively small firm doing consulting and tech support for it (the one WV used).

What's with this? One comment in the article is that no one has any financial interest in marketing VistA. Apparently it's easier for a major player in the software industry to design its own crappy EMR, rush it into production before it is properly debugged, and market the heck out of it, and hospitals will eagerly lap it up.

So what does any of this have to do with pharmaceuticals and ethics? Many of the defenses of how today's pharmaceutical industry operates, and why docs should jump into bed with the industry, are examples of extolling the imagined virtues of the "free market." We know that in many ways, health care represents a huge area of market failure--as evidenced by the lack of any conceivable system by which the unrestrained market on its own will provide universal coverage. The EMR seems to represent yet one more example of market failure--what makes the most sense, and best serves the public health, is not what's most marketable, and vice versa. Bottom line: stop worshipping the free market and look at the facts. As one wag put it, the market is a great thing, but it needs adult supervision.