The hope and the hype of health IT.

T here is an old saying: If all you have is a hammer, every problem looks like a nail. I find this maxim coming to mind again and again the more I read about information technology being the supposed solution to the myriad problems facing health care. Electronic health records (EHRs) are probably the single most talked about piece of health information technology (HIT) today. EHRs have been strongly supported by various medical societies, including the AAFP, and by leading figures of both major political parties. The federal government has even earmarked billions of dollars to incentivize meaningful use of EHRs and to encourage widespread adoption. (Full disclosure: I implemented an EHR in my practice almost nine years ago.) Although the hope is that EHRs will improve quality and reduce costs, current studies do not demonstrate this. On the issue of quality, consider these findings recently summarized in the Wall Street Journal: • In an analysis of some 1.8 billion ambulatory care visits, researchers found that EHR use made no significant difference in performance on 14 of 17 quality indicators. EHRs were equated with better performance on two quality indicators and significantly worse performance on one quality indicator. Researchers concluded that EHRs “were not associated with better quality ambulatory care.” • In a systematic review of 86 published papers on the use of EHRs in primary care, researchers found that “quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation.” • In a study of the influence of EHRs on adherence to evidence-based guidelines for treatment of heart failure among more than 15,000 outpatients, use of EHRs was associated with improvement in the delivery of quality care on just one of seven care measures. • In a systematic review of the effects of handheld EHRs on clinical care, researchers found that incorrect or redundant diagnoses occurred more often when physicians used electronic records than when they used paper records (48 instances versus 7 instances). They concluded, “This highlights another area where informatics interventions are being implemented widely without rigorous evaluation.” But what about cost savings? A recent study that reviewed the financial impact of digitizing medical records at approximately 4,000 hospitals “found no evidence that computerization has lowered costs or streamlined administration.” Could a too timid embrace of HIT account for the findings? Apparently not: “Even the select group of hospitals at the cutting edge of computerization showed neither cost nor efficiency advantages.” Physicians are in the business of diagnosing illness and treating patients. Practical HIT has to further that goal. The mobile drug-reference tool known as ePocrates seems to fit the bill. It enables health care providers to quickly look up medication dosages, interactions, contraindications and so forth. Unlike most HIT, it’s simple, pragmatic and actually works. That’s why approximately 280,000 physicians in the United States use it. Physicians aren’t technophobes or Luddites. We’re ready for HIT, but most HIT isn’t ready for the real medical world.