My initial reaction to the link to a recent poll analysis showing how little the public understands the value of EMRs was their intended "ignorant public" reaction. I then shift to an "ignorant pollsters" reaction, with a bit of wondering about whether it was ignorance or deliberate.
I think that the public answered a different question than the pollsters thought they had asked.
It seems likely that the public answered the question "who will benefit from the US government spending and regulation on EMRs", not the polling question about the "benefits of EMRs". For obvious reasons my mind turned to GOSIP. A similar question mismatch about "benefits of an Internet" versus "who will benefit from US government spending and regulation of GOSIP" would have a similar result. GOSIP was a multi-billion dollar waste that caused delay and harm to the acceptance and growth of the Internet. The US spending on EMRs could go down the same path.
As with GOSIP, the problem with the present EMR push is not with the technical concept, the problem is with the government spending and regulation approach. I think that is what the public answers reflect. They do not think that this government spending and regulation will have the claimed benefits.
The advertised functional goals for the EMR are twofold:
- Reduce costs, and
- Improve patient outcomes.
I will believe that a project will reduce costs when the project plan includes a proposed layoff size. We are past the "let's build one and see what happens" stage for EMRs. By now there should be a reasonable plan for layoffs of staff that will result from the EMR installation, where these layoffs result in savings that exceed the cost of installing and operating the EMR. I'm not asking that these be perfect. I've seen how things change as projects progress. But if layoffs are not even in the plan at the beginning, there is no credibility for claims of cost savings.
I have seen plans like this in RIS/PACS installations and some EMR installations. The systems are justified by layoffs of couriers, elimination of staff overtime, the elimination of warehousing, equipment maintenance, etc. The results don't always match the plan, but in general there are real savings.
I will believe the goal of improved patient outcomes when there are clinical trials and statistical evidence that show a reason to expect improved patient outcomes. A blind faith of "technology will save us" is not accepted elsewhere in medicine, and should not be accepted here. There is plenty of potential, but does it work in the field? This needs to be evidence based.
Again, in RIS/PACS/EMRs there are sometimes situations where equipment is installed because it improves patient outcomes. There are clinical trials and there is statistical evidence gathered showing that these technologies do improve patient outcomes.
I will believe an outcomes motivations for an EMR project when I see sound scientific evidence in the justification for project features.