Letters consider evidence-based benefits of electronic health records as well as impact of use of electronic health records on physician productivity.
Are the 'benefits' of EHRs evidence-based?
Dr. Joseph Scherger boldly stated that, "Meaningful use of HIT saves lives" (From the Board, May 7 issue). I try to keep up on the medical literature and latest studies as best I can but have not seen any studies to back up his assertion. Considering he cited no studies in his editorial, could he please forward any data that back up the assertion, which appears to be cited as fact?
Evidence-based medicine must be applied to everything, even things you fully believe are correct. We have seen a number of assumptions thought to be fact that were later disproved by scientific evidence. Consider the guidelines for blood pressure control in diabetics. It was previously thought that it must be preferable to have better control, but the ACCORD study demonstrated that not to be the case. We are also finding that tight control of blood sugars is not necessarily the best treatment, contrary to what was thought to "obviously be true" by the medical establishment.
KEITH VANCURAN, MD
Dr. Scherger responds: For ample evidence that "paper kills" and EHRs save lives, read To Err is Human: Building a Safer Health System, a consensus report by the Institute of Medicine (1999), especially the chapter on health information technology. You can read the report at http://iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx.
Also, Newt Gingrich's book Saving Lives and Saving Money: Transforming Health and Healthcare contains additional information: http://www.amazon.com/Saving-Lives-Money-Newt-Gingrich/dp/0970548540.
EHR users are 'pioneers'
The cost of the EHR system at Community Care Physicians, PC, is $2.8 million-$18,000 per physician per year ("Meaningful users," [by Morgan Lewis Jr., Senior Editor], May 7 issue). As promising as EHRs are, too little is made of the cost-in dollars and lowered physician productivity. Physicians need to know that most of these systems are still in the pioneering stage. You can recognize pioneers...by the arrows in their heads.
JEFFREY J. DENNING
La Jolla, California
Editors' response: Certainly, EHRs can be expensive depending on the product, but Community Care has earned an additional $4.5 million through its participation in patient-centered medical home programs sponsored by regional private insurers, which the practice's medical director says would not have been possible without the data accessible through its EHR system.