(2009-04-24) Busweek Emr Skepticism

Business Week questions the ARRA-triggered EMR push. But red flags raised by doctors and researchers haven't gotten much attention in Washington, in part because the health-tech industry has forged strong ties to the President, his top medical advisers, and Republican heavyweights such as Newt Gingrich. Nancy Ann De Parle, the new White House Health Reform czar, recently stepped down after eight years as a member of Cerner's board of directors... Glen Tullman, CEO of All Scripts-MiSys (MDRX) Healthcare Solutions, a big Chicago vendor to doctors, became acquainted with Obama when he ran for the Senate in 2004. The pair worked out at the same Chicago gym and occasionally played basketball. At that time, Tullman gave Obama a personal demonstration of his company's software at Allscripts' headquarters and went on to serve on Obama's Presidential campaign finance committee."

Lobbyist-s for Mc Kesson (MCK), a large medical supplier based in San Francisco that already generates $3 billion a year in health technology sales, are distributing a position paper to members of Congress and Administration officials that could help steer stimulus dollars toward the company. The document, reviewed by Business Week, addresses the definition of "meaningful use" of electronic records (Meaningful Use Of EMR). That is the standard Congress set for hospitals and doctors seeking incentive money; it is now up to the Obama Administration to refine the term. The Mc Kesson [paper](http://sites.mckesson.com/doctors/documents/Mc Kesson_Healthcare_IT_Recommendations.pdf) (PDF) urges a requirement that recipients "build on existing technologies" - language that could favor products of Mc Kesson and other established vendors.

Koppel, the researcher at Penn, has sounded some of the loudest alarms. In 2005 he published a study in The Journal of the American Medical Association (JAMA) that examined an Eclipsys system at the university's academic hospital. He found that use of computers introduced 22 new types of medication errors. His goal was to discover why young medical interns make so many Medical Error-s. He hypothesized that long hours were to blame. To his surprise, the problems stemmed mostly from software installed to prevent mistakes... When health technology fails for one medical provider, there is no central mechanism for reporting problems to others who use it. The federal government collects and disseminates this kind of information on drugs and medical devices. But tech contracts routinely bar medical providers from disclosing systemic flaws. Koppel contends this is unethical and risky: "We need to collect what we know and head off (any potential) tragedy."

Del Beccaro soon became troubled by incidents of children suffering medication overdoses despite alerts from the Cerner software... He asked the doctors involved whether they had seen the alerts onscreen. "They told me, I get so many alerts, I click through (them), " Del Beccaro says. "They do become mind-numbing." "AlertFatigue" is a common concern at hospitals.

Children's National Medical Center in Washington, D.C., has had a similar experience. In 2006 doctors and nurses there say they discovered an eightfold increase in dosage errors for high-risk medications. They attributed the trend to a Cerner system installed six months earlier.

The company faced more questions over its technology at the University of Pittsburgh Medical Center (UPMC). In 2005 researchers there found that at the university's Children's Hospital, patient deaths more than doubled, to 6.6% of intensive-care admissions, in the five months following the installation of a computerized order-entry system. The research on child patient deaths at the University of Pittsburgh found a "direct association between (computerized records) and increased mortality," according to an article published in December 2005 in the medical journal Pediatrics. Digital technology slowed treatment in several ways, the researchers concluded. One example: Doctors and nurses in the intensive-care unit were accustomed to ordering medications and tests while a sick child was en route to the hospital. The Cerner system required that orders be submitted only when the patient arrived, costing crucial time.

David Blumenthal, the new Obama health-tech chief, declined to comment on CCHIT. But in an article published this month in the New England Journal of Medicine, he said the body needs to set stricter standards: "Many Certified [[EMR]]-s are neither user-friendly nor designed to meet (the stimulus law's) ambitious goal of improving quality and efficiency in the health-care system." See [z2009-04-09-BlumenthalStimulatingEmrUse].