I Guess the British NHS Was an Exception

This is David Blumenthal, former national coordinator for health information technology, interviewed by James Fallows in The Atlantic:

Laptop and StethoscopeWhen the benefits of using better technology are “internalized,” as the economists would say, there has been much more rapid, complete, and effective adoption of electronic medical records. So, the VA: the benefits are internalized, because the VA has to live within a budget. In private health-care organizations like Kaiser or the Geisinger plan in Pennsylvania, or the Group Health Cooperative in Puget Sound, electronic medical records were adopted decades ago, and are widely used and highly effective.

Here is Linda Gorman on health IT in the National Health Service.

Comments (14)

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  1. Martin L. says:

    Blumenthal talks about the importance of competition. He claims that the regulation that is being imposed, as well as the barriers to compete are causing the the industry to lag. The lack of competition is directly affecting the quality of the healthcare and patients are suffering from it. It is time that government focuses on what is best for the people, rather than in the interests of few individuals.

    • Matthew says:

      “But from the provider’s perspective, there are substantial costs in setting up and using the systems.”

      There are substantial start up costs, but one would think after the initial cost, the benefits would outweigh costs. Monetary costs, the cost of learning and getting everyone accustomed to the new system is a barrier, but after that it should function efficiently.

      • Bill B. says:

        There always seems to be, to a degree, resistance of adapting change in health care settings, especially regarding technology. Just look at the problems implementing ICD-10 codes in offices.

  2. Blake R says:

    Information is key in the healthcare industry. It will be much better if a patient’s history is stored in a computer, than relying in the memory of a patient. There are things that are understood among doctor, that patients cannot explain. More information is more benefits to patients, so we should push to have better ways to handle information.

    • Thomas says:

      How information is stored is also a great benefit to patients, which signals the importance of incorporating technology with health care.

      • Trent says:

        How safe is the information in these records though? Sure with our current technology the defenses are tough, but what about the future of cyber offense?

  3. Paco H says:

    Adapting technology to the healthcare industry is required, and is something that will take time. We cannot expect the industry to deliver results now on changes that were employed few years ago.

  4. Buddy says:

    “This is a transition issue. Most physicians’ offices, and I’ve been in a lot of them, are set up so that when the physician looks at the screen, he or she can’t look at the patient.”

    It could be argued that a bumpy transition into using more technology can take away some of the intimacy in the doctor patient relationship. It can go from a patient being a person to just another tab on the chart quickly.

    • James M. says:

      While that is possible, it will increase efficiency, something desperately needed at this point in improving the quality of health care.

  5. Linda Gorman says:

    From the quote, one would think that scale simply doesn’t matter. And that medical records are essential for treatment. They aren’t, in many cases. And there isn’t much evidence, other than their adoption by some practices, that they actually improve care or save money.

    Big record systems are expensive. Small companies do not have the same accounting or record systems as big companies for good reason. There is no reason to think that medical care is any different in this respect. If electronic records do help a particular practice, then one would expect that they would be used.

    Whether the VA record system is all that it is cracked up to be is an open question. Its claims have not been validated by an external audit.

    At least some of the physicians who work at the VA say the records are so poorly organized they can’t get the information they need rapidly enough. The system has also been criticized for being clumsy and error prone (the records often have errors because people use cut and paste to fill them in).

    Kaiser and Geisinger are big companies. Electronic records may make sense for them, but not for the people who treat people who don’t want to be members of Kaiser and Geisinger.

    • Trent says:

      How do medical records not improve treatment? Wouldn’t their history of issues lead to an underlying conclusion?