Ridiculous Study of the Week: EHRs Save Lives

The idea that an electronic health record (EHR) or electronic medical record (EMR) saves lives never occurred to me.  I would think that good doctors with good nurses on a good team in a good hospital really did the trick.  But what the hell do I know?  To a few researchers, however, they found it their mission to place all the importance on the EHRs.  This is what they found:

Evidence linking electronic health record (EHR) adoption to better care is mixed. More nuanced measures of adoption, particularly those that capture the common incremental approach of adding functions over time in US hospitals, could help elucidate the relationship between adoption and outcomes. We used data for the period 2008–13 to assess the relationship between EHR adoption and thirty-day mortality rates. We found that baseline adoption was associated with a 0.11-percentage-point higher rate per function. Over time, maturation of the baseline functions was associated with a 0.09-percentage-point reduction in mortality rate per year per function. Each new function adopted in the study period was associated with a 0.21-percentage-point reduction in mortality rate per year per function. We observed effect modification based on size and teaching status, with small and nonteaching hospitals realizing greater gains. These findings suggest that national investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time.

I cannot find the full study and refuse to pay money for it.  I just don’t care enough.  I am no statistician, but it is hard to fathom that a .11% or a .09% change in mortality rate means anything.  I am also perplexed with the “new function adoption” discovery they found. What does that mean?  “Hey, Barbara, I found the a way to copy and paste!  Let’s just use that instead of adding any new information?”

Overall, this study just seems ridiculous.  It is has no depth.  No “aha” discovery.  Intuitively, EHRs can be good if they are workable and not overly complicated.  Once you mix in quality indicators, absurd layers of security, and fluffed notes for billing then they become a piece of crap.  Just my thoughts.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Ridiculous Study of the Week: EHRs Save Lives

  1. Pat
    July 14, 2018 at 8:08 pm

    “…particularly those that capture the common incremental approach of adding functions over time in US hospitals…”

    What the hell does this gibberish mean?? Seriously, wha does these words together mean?

    • Sir Lance-a-lot
      July 14, 2018 at 9:56 pm

      Yeah, Pat, it’s kind of funny that people who have no problem instantly understanding “idiopathic biliary atresia” or “autoimmune reflex sympathetic dystrophy” can be completely unable to parse a phrase like that, especially when it is putatively within their own field, but you’re right, I have no idea what the hell they’re saying either.

      • Pat
        July 14, 2018 at 10:27 pm

        ????

  2. Sir Hakum of Hugo
    July 14, 2018 at 2:15 pm

    My EMR warns me that it cannot tell if there is an interaction between a wheelchair and Tylenol.

    EMRs do not allow a physician to see the big picture. I have always imagined my staff asking about sexual activity and the name of their 3rd grade teacher. when the patient is in the midst of ACS. I fear for the newly indoctrinated into our profession.

    In the old days, we just didn’t know the patient’s name at worst. Today, I can barely manage a peak over the top of my laptop at them.

    The whole person approach from medical school is no match for the mind numbing, spirit killing, knuckle busting keyboard of a bullet point EMR.

    • Kurt
      July 18, 2018 at 9:06 am

      Agreed, The local er pulls med lists out of their asses. I have to try and figure out. The resultant stresses are the reason for me retiring as soon as I hit medicare age. Errors propagated by a mouse click. At least in the past, the brain had to be engaged before the pen was moved!
      Pharmacists used to call and correct us when the patients specialists changed a drug. Not anymore.
      Med lists in EHR is a quagmire of duplications and outdated drugs that are a bitch to fix with the “pull downs”. I tell people to keep track of the meds or we docs and hospitals are going to kill them! The elderly I ask to enlist their families or I do the best I can.

  3. PW
    July 14, 2018 at 11:24 am

    I take the opposite view. EHRs will kill medicine and patients.

  4. Steve O'
    July 14, 2018 at 8:29 am

    More nuanced measures of adoption, particularly those that capture the common incremental approach of adding functions over time in US hospitals, could help elucidate the relationship between adoption and outcomes.
    Is there anything more to say? We are steadily creating a language, as Orwell noted, which is unable to say anything precisely. Now, we are automating it!
    Each new function adopted in the study period was associated with a 0.21-percentage-point reduction in mortality rate per year per function. We observed effect modification based on size and teaching status, with small and nonteaching hospitals realizing greater gains. These findings suggest that national investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time.
    The ability to find things that interest one is not particularly admirable. Village Idiots in history have been able to find things that are odd, smelly and unspeakable. Now, we give them academic positions and ask them to find things that make them think about other things.
    It is no good having thinking machines which talk to those who cannot think. The machines get stupider rather than smarter.

  5. Sir Lance-a-lot
    July 14, 2018 at 7:47 am

    My EHR saves lives every day, such as when it tells me that Advair is contraindicated in cases of asthma, or that amoxicillin is contraindicated in pediatric patients.

    • Steve O'
      July 14, 2018 at 8:30 am

      Ah, but we are on a new outcome development movement – “Let Nature Take Its Course.” That will minimize medical errors, as there are to be no medical efforts. It is a bold new leap into paleolithic medicine.

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