Faculty members share their insights on current events with Dartmouth Now in a question-and-answer series called Faculty Forum. This week, Professor Denise Anthony talks about the issues surrounding electronic medical records.
Denise Anthony is an associate professor and past chair in the department of sociology. She is also research director of the Institute for Security, Technology, and Society (ISTS) at Dartmouth, and a faculty affiliate at the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.
As one of the principal investigators on a project funded by the National Science Foundation (NSF), Anthony is conducting research on the policies and social production of privacy in electronic medical records as part of an interdisciplinary team of researchers at ISTS. The other principal investigators on this NSF project are David Kotz, the associate dean for the sciences and the Champion International Professor in the Computer Science Department; Sean Smith, an associate professor of computer science; and Eric Johnson, the associate dean for the MBA Program, Benjamin Ames Kimball Professor of the Science of Administration, and the director of the Glassmeyer/McNamee Center for Digital Strategies at the Tuck School of Business.
In May, ISTS hosted the second Securing Information Technology in Healthcare workshop, convening more than 50 experts in the fields of information security and health care privacy. And on October 9, Anthony will be part of a panel discussion, “N.H. Health Care — Is There Good News?” This event is sponsored by NHPTV and ILEAD and will be held at 4 p.m in Filene Auditorium. The talk is free and open to the public, but registration is required.
The U.S. government is spending $30 billion on information technology (IT) related to health care, and recent articles and op-eds have been critical of this expenditure because it hasn’t led to the promised cost savings. An article in The New York Times reported that the “move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients.” What’s your take on this?
Costs are one important piece of the puzzle of improving the U.S. healthcare system. But the other, maybe more important piece is improving quality. And part of our concern about spending so much isn’t just how much it costs, but that we’re not getting the value out of what we’re spending. A lot of evidence from The Dartmouth Institute for Health Policy and Clinical Practice and others demonstrates that, for what we’re spending, the quality is not as high as what other countries are getting. So attention to cost is very valid, but it’s only one side of the story. Improving quality is the most important thing we need to do.
And in some of the National Science Foundation-funded studies we’ve done here at ISTS, hospital electronic medical record systems (EMRs) are associated with improved quality. Now there are some caveats in that the most advanced systems aren’t as associated with quality as the next most advanced systems. So we recommend that the push for health IT is really necessary and important for health care to improve quality, but it’s not going to be a perfectly linear process of just constant improvement and cost-savings. It’s going to be very uneven, and it’s already very uneven across the country in terms of who is putting EMRs in place and the effectiveness they’re getting out of them.
Keep in mind that this is a huge shift for the entire industry and it’s going to take some time. But to transform health care and really improve quality and control costs, we’re going to have to move to more digital electronics systems throughout the industry.
What are some of the challenges?
Some of the hurdles are the fragmented healthcare system, which means that the value of those new EMRs is not necessarily produced. It’s not just because of the EMRs themselves, it’s because of the fragmented organization of the delivery system. That’s why calls for things like accountable care organizations are really also necessary alongside improvements in the IT systems to bring about better quality and hopefully better value.
Some of the other challenges are around some of the EMRs, which aren’t as advanced or as user friendly as they could or should be. They haven’t been designed with the providers who use them, and so physicians and nurses are finding that they’re having to do more work to use these systems. That is certainly not ideal and those criticisms are absolutely valid.
As part of the Dartmouth team’s research, you’ve been looking at the security and privacy of health information technologies. Your piece of the research entails interviewing health care stakeholders—physicians, nurses, hospital administrators, patients—about the advantages and challenges of electronic health records. What are you hearing so far?
As we move patients’ intimate health information into an online or digital environment, there are new challenges for privacy. Physicians and nurses and everyone in the health care system are well trained and have confidentiality as one of the pillars of their professions. But they don’t have full control over access to new EMR systems. Health care delivery is not just you and your doctor. It is a team of providers who are doing lots of things to give the best medial treatment. So patients, among others, are concerned about the extent to which information might be exposed, leaked, or used in ways that are not beneficial to them.
What we’re finding is that some groups of patients, in particular those who might have sensitive health information or potentially stigmatizing health issues or social issues, do worry about how that information is going to be available through their health record.
So it seems great that all your providers are able to know your health conditions and symptoms, yet a lot of patients don’t necessarily want every provider to know everything. If we don’t have privacy protections in place, some of the potential negative consequences are that patients will be reluctant to share information with their doctors. And some people may not use the health care system at all.
So the challenge for policy-makers is to make sure that recommendations for the technology and the uses of that technology and information are set at the right level to promote the best quality healthcare and facilitate the high value of that information for health care while protecting patients’ privacy. That’s a tough challenge that has to be continually negotiated, to some extent. We’re not going to get it right the first time, but the idea is to have some flexibility to keep improving.
How far are we from having a system people are happy with?
We’re already seeing some benefits in the system. Certainly those are not as widespread as they should be, and there are still real challenges. But I think in the next five years we’re going to see a transformation in health care brought on by new technologies.
It’s not a silver bullet, but information technology enables a lot of changes that we think are going to be necessary to deliver better care, to get more value out of health care, to give patients better access to health care and to their own information. Maybe to even use technology in ways so they don’t always have to go into the health care system, but can manage at least some aspects of their health themselves. None of that is possible without information technology. But how we implement and really use it are where all the interesting and important questions are.