nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Sunday, January 23, 2011

Study: Benefit From Electronic Health Care...Not So Much

This was a large scale review of over 50 studies, examining multiple aspects of electronic records, pharmacy, decision-making, adherence to standards.  They found benefits to be overrated.

This study was published in an online journal.  You can read the whole thing here (PLoS Medicine).  The Wall Street Journal also covered it in their Health Blog (Jan 21).

The interesting thing is, electronic health records, computer ordering, computer-driven practice guidelines, and the like are all being heavily promoted by advocates, commercial software vendors, politicians...and the President of the United States.

I'll give you some of the data below, but here's a quotation from the authors' conclusions:
"There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology's life cycle."

So, why do they say this?   Here's the chart reviewing the benefits from computerized decision support systems (which help in the diagnostic process):

Note that "patient outcomes" on the right all showed no benefit (that's what '+/-' means).  If you take the time to look through the charts for other variables like electronic health records, order entry, e-prescribing, and data storage, you find the same.   Where it really matters, under "outcomes" (that is, doesn't the patient get better, or better care), the pattern is mostly the demonstrated benefit.  Shouldn't outcomes be our highest priority?

Another pattern on the charts is that (1) time required, and (2) costs both go up with eHealth systems--not a savings as the advocates promise.

Health Care Reform is already spending what will amount to many billions of dollars to implement these systems, in the authors words "as if it was a given" that health care will improve.

I'm not convinced.  And I'm not against electronic systems.  But before we throw tons of money at them, there needs to be standardization, proven benefit, and demonstrated cost-savings.

To be fair the data isn't all negative.  Pharmacy prescribing shows a solid benefit in "improving organizational efficiency".  There are several other small areas where some good was achieved.

But overall, we're assuming too much and spending too soon.

Doc D

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