Q: What have early adopters of electronic health records experienced? What key factors determine their success?
Jim Schibanoff: There’s a combination of what’s actually occurred, what medical evidence shows about what electronic health records do to improve care, and then what is the promise. We tend to hear more about the promise of the future than what has actually been proven to be effective. The thing that has been proven to be effective is in the hospital setting where physicians use the computer to write orders that are legible, cannot be mistaken in the decimal point, or the number can’t be mistaken. Medication errors are drastically reduced, and the turnaround time from the time that the order is written until the medication is delivered to the patient is markedly reduced. That we’re agreed upon.
Everything else is a hope and an expectation depending upon factors that we’ve already heard. Just putting computers into a broken healthcare system makes it faster—and broken. You need to improve the healthcare system as you make it electronic. You can’t have one without the other.
Q: It’s important not to over-promise or present it as a panacea. What do you mean by “a broken healthcare system”? What are the things that electronic health records can’t fix?
Jim Schibanoff: The fragmented system has conflicting incentives—the incentive to keep the patient in the hospital longer because that’s what the financial gain is, the incentive for the physician to order more tests and do more procedures. There are many countervailing incentives that need to be aligned, and the fragmentation needs to be brought together. The electronic health record can help that if the underlying processes of care are addressed with different financial incentives and different policies that allow the electronic record to be a catalyst for change, as opposed to just another additive technology. Healthcare is bereft with one new technology after another that’s just been layered on and layered on, and none of them have been truly transformative. Electronic health records can be transformative, if the processes of care improve.