Tuesday, September 25, 2012

Another Example of Industry Spreading Non-Facts: Health Information Technology

While I try not to tread on the territory of our friends over at the Health Care Renewal blog, and keep this blog devoted to pharmaceutical and device industry issues, I've had occasion in the past to mention the good work of Dr. Scot Silverstein (see for example http://brodyhooked.blogspot.com/2011/03/industry-doublespeak-this-time-in-it.html). Dr. Silverstein is a highly informed critic of the bad sorts of electronic health records and other uses of health information technology (HIT), which unfortunately today may be the majority of uses. This has put him in the unhappy position of being blasted by the many hyperenthusiasts of HIT within medicine, as well as the industrial providers of HIT. As Dr. Silverstein has documented liberally in his posts, if you dare to suggest that HIT is anything less than perfection itself, the response of the enthusiasts makes the extremist-fundamentalist Muslim reaction to the recent idiotic anti-Mohammed video look like a friendly conversation over coffee.

In the recent post in question: http://hcrenewal.blogspot.com/2012/09/wsj-koppel-and-soumerai-major-glitch.html--  Dr. Silverstein mentions a recent column in the Wall Street Journal (no need for a separate link as he repeats virtually the entire opinion piece) by Stephen Soumerai and Ross Koppel, two similarly distinguished experts. In turn Soumerai and Koppel refer to a recent study out of McMaster University:
http://jamia.bmj.com/content/19/3/423.long

Cutting to the chase in all this, the bottom line is that when the politicians jumped on the bandwagon and called for massive Federal outlays to support and encourage quick adoption of HIT, they were motivated a little bit by promises that electronic records would make medical errors disappear, but no doubt even more by promises of cost savings--even to the point that they fondly imagined that they could spend billions buying HIT systems that would in the end pay for themselves in reduced costs. Just to add a personal note, if I ever believed that electronic records would save mioney, I stopped believing it after attending a meeting of department heads at my own medical center. One head estimated that the faculty now spent an extra 30% more time just completing the required electronic record tasks, and no one else disputed that estimate. I concluded that any technology that reduced physician productivity by 30% was unlikely to be a big money saver overall. (And our medical center owns one of the supposedly better HIT products.)

So the new study by O'Reilly and colleagues at McMaster looks specifically at drug ordering systems, and reviewed 31 research studies that in one way or another addressed the economics of the systems. The conclusion was that while a few studies suggested possible cost savings, the general quality of the research was poor, and one would have to conclude from the overall pattern of what us now known that there's no good evidence that electronic records save money with regard to drug ordering. Soumerai and Koppel, and Silversteion in turn, generalize this to HIT across the board and claim a lack of evidence that any of these promised cost savings are coming to fruition. Given hyped-up predictions of up to $100B in annual savings from wide adoption of HIT, this is indeed (as they used to say on the old TV sitcom) a revolting development.

What we see in the HIT industry seems to emulate a pattern we've seen many times in Pharma. A new drug is rushed onto the market because of some presumed advantage that puts it way ahead of existing drugs. (Think glitazones for diabetes, or COX-2 for arthritis.) As soon as careful studies can be carried out, the supposed advantages of the new kid on the block turn out to be illusory, and the downside starts to become glaringly apparent. But the industry is raking in too much cash to let that negative message get out, and so does its best to stonewall any disclosure of the new information. In the process it calls upon all of its lackeys inside medicine, who use their big university credentials to bolster the industry cause. In the case of Pharma, it seems usually to be the case that these "key opinion leaders" have simply been bought. HIT is different in that the issue seems to be genuine enthusiasm (not to say zealotry) among the early adopters, who then would look so silly if they admitted the validity of the new data that they dig in their heels and attack the messengers.

Dr. Silverstein repeats as often as anyone will listen that HIT holds great potential promise and that he's not against HIT. He's against poorly tested HIT that's rushed into use when it should still be considered experimental. Again, sadly, that seems to be most electronic record products now in use in the US, with more coming on line every day due to the Federal stimulus support and the Affordable Care Act.

3 comments:

InformaticsMD said...

Correct link is:

http://hcrenewal.blogspot.com/2012/09/wsj-koppel-and-soumerai-major-glitch.html

Somehow "--Dr." got appended to your link.

Howard Brody said...

Scot, thanks for correcting this, I hope the link is now correct in the revised post. Howard

Anonymous said...

thanks for sharing..