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Unhappy Camper (Volume 2, Issue 4)

Recently the ProJo (http://www.projo.com/opinion/contributors/content/CT_welch12_05-12-11_0K... ) republished an interesting opinion piece from the Washington Post written by H. Gilbert Welch, MD: ‘Diagnosis is disease in US health system’ that should be read by all practicing physicians. Dr. Welch is with the Dartmouth Institute for Health Policy and Clinical Practice. He explains that attempts to meet current practice quality measures result in lowered thresholds to diagnose our patients with a disease states. “In short, low thresholds have a way of leading to treatments that are worse than the disease.” To be fair, Welch gives only partial blame to the adoption of electronic health records, for it’s really not EHR that causes us to overdiagnose and overtreat our patients, rather, it’s our stumble to meet Meaningful Use and P4P quality incentives that are largely based on EHR adoption.

The ironic end result is that the bean-counting governmental and health insurance companies that have made Meaningful Use and P4P their darlings can’t seem to fathom that they are shooting themselves in their feet. Costs skyrocket as more and more people are overdiagnosed with, and treated for marginal conditions, and quite possibly harmed by the whole process. This trend to medicalize previously normal or variant conditions is multifactoral to be sure, but EHR is definitely the powerful facilitator in driving up the cost for health care. It’s been stated before that the motivating force behind these governmental and insco drives to EHR adoption is the need to prove the quality of health care that is being sold to the employers that actually pay the insurance premiums. The reality is that these same employers will be paying more and more to obtain that proof, proof that is spurious at best.

Many of us who are past the agonizing throes of adopting EMR are now experiencing the equally agonizing throes of trying to tweak our EMRs into compliance with Meaningful Use criteria. Ummm, perhaps tweak is the wrong word—sledgehammer is much more appropriate. Many, if not most, of these costly EMR systems are far removed from any Meaningful Use prime time status.

Sure, in our march to EMR we have adopted some process changes, perhaps some that are even beneficial. But many of our computerized processes are merely smoke and mirror changes that reflect our need to hammer our clinical data sets into the neat little holes set up to achieve compliance with Meaningful Use and P4P measures (see http://www.docehrtalk.org/messageboard/2010/09/17/chasing-meaningful-use... ). Employers need to know that such indicators only measure medical compliance, not medical judgment. For despite the proclamations put out by RIQI, “health information technology and how it can improve the quality, safety, and value of healthcare throughout Rhode Island” remains just smoke and mirrors.