The Other Upside to Electronic Health Records

For those readers who may’ve seen my op-ed in Wednesday’s NYTimes on electronic health records, there’s one upside that I didn’t mention.

The predominant argument for EHRs - including mine - is that they’ll make for better individual health care and, system-wide, can save lives and money. What’s more, if a national standard for EHRs emerges, such as WorldVista, the system I wrote about, then the US health care system could in fact be faster, more efficient, and more connected as well.

All that is true, and it is, to my mind, reason enough to spur the government (via CMS or some other HHS agency or program) to promote the adoption of EHRs as soon as possible – like now.

But there’s one more great side effect of EHRs - the data.

If the US health care system was to move to nationwide electronic records, and if those records were largely standardized and exportable, there would be an unprecedented reservoir of health data for epidemiologists and researchers. The benefits wouldn’t just be statistical or demographic - who’s dying when of what, etc. Think bigger: With information on millions of Americans health histories, we could ascertain what sort of treatments work - and which don’t. We could see what the optimal time for interventions is, and when is too late or too early. We could see where in the country we are doing things right, and where things are going wrong (who knows - maybe Mississippi has some health secrets that aren’t turning up in the rudimentary record-keeping we now have).

If you’re wondering about privacy concerns, I have two answers. First, the cheeky one: Get over it. I think our national obsession with privacy, especially on medical histories, is overblown and self-defeating. Other countries don’t worry nearly as much about privacy issues, they have set up remarkably rich electronic health systems, and they’re already pulling out reams of great data that help them treat their citizens better. (Want to know whether autism is related to vaccinations? It’s not - Sweden proved that already, thanks to their swell record-keeping.) And that’s not even counting the upside once genetic information starts dropping into the system.

Second, the pragmatic answer: Stop your worrying. We have plenty of laws that provide for privacy of health records (HIPAA, etc), and if anything they’re too strict about the stuff. What’s more, the data I’m talking about can be completely anonymized. We don’t care what’s wrong with Joe Brown from the Upper West Side – we care about what’s wrong with the Upper West Side.

Right now, all that data is just slipping away, and researchers have to look to other countries - countries that are smaller, less diverse, and differently structured - and awkwardly extrapolate to the US. I talk to researchers about this - especially data wonks - and at first they get so excited about the potential, about all the studies they could do, all the questions they could answer. But then they wake up - they’re resigned to getting those answers elsewhere, or forgoing them, because we simply don’t have a mechanism to turn what your doctor does for you into data that can be combined with what everyone else’s doctor is doing for them.

The fact is, the US has the best medical care in the world despite itself. We don’t really know what we’re doing, or what works, in any really scientific way. Sure, we have studies that show - under very controlled circumstances - what sort of treatments work. These demonstate statistically significant results under laboratory conditions. But in practice? In the real world of clinical practice (small scale)? In the real world of health care practice (large scale)? It’s a total crapshoot. In the worst case, that’s partly why we have these massive after-the-fact pharmaceutical recalls; because we (they) didn’t really know what was going to happen once the real world scenario started to play out. The data simply isn’t available.

This is the real bonanza of electronic health records in the US. The data become available. But let’s be honest: The fact is, it’s an argument that won’t change anything, won’t ever get anything done, because there’s no personal benefit. It’s all in the abstract. But gee, it’d be great to get there…

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Published by: tgoetz on May 29th, 2007 | Filed under Policy

12 Responses to “The Other Upside to Electronic Health Records”

  1. James J Murata Says:

    Interesting theory….I think that the technology to collate the information is not yet available…I provide information to a national database..government sponsored…but there is no place for outcomes, only visit diagnoses and therapy….The problem will be interpreting the information and how much value we should give to such physician provided information as reliable…

  2. Michael D. Miller, MD Says:

    Nice Op-Ed, and interesting comments. One of the challenges of data analysis from EMRs is being sure that your analyses are accurate and not artifacts due to improper or incomplete data entry. For example, with some EHRs (and I’m not sure how Vista or WorldVista handles this) clinicians can gravitate to using open-text fields rather than specific choice menus/options since the open-text fields are like the notes they are used to writing in paper charts. The result is that extracting data from text fields is hard, and if it is missing from the other sections of the record (because the clinician put this information into the text field), then analyses can be flawed if they miss this information….. Overall, the challenge of successful implementation of EMRs (and other health IT applications) are 10% technological and 90% getting the users to use the use the systems properly/optimally.

  3. Vijay Goel, M.D. Says:

    Nice article. I agree though with Michael’s comment that the challenge with EHRs isn’t the technology, but their adoption by physicians. I took a look at this while part of McKinsey, and one conclusion was that there is significant economic misalignment between who pays for the EHRs (providers) and who gains the benefits in a fixed-reimbursement, volume based payment system (payers).

    It’s a pretty tough sell to get the docs to spend a lot of time and money adopting a system (not standards based) where someone else will reap the benefit. The economics/ incentives need to be fixed before we start seeing widespread organic adoption.

  4. elizabeth brandt Says:

    I am looking forward to learning to use VistA- I will be an intern in Outpatient Mental Health at the VA next fall. I appreciate your Op-ed, and I generally agree with your argument that electronic records can improve treatment and facilitate the transfer of records. I do, however, have some concerns about patient privacy. My concerns are based in my work in rural Alaska: the Native hospitals in Alaska share records across the state, and often young people do not want to be tested for STIs and other stigmatized infections because they believe relatives who work for the health system will have access to their records. In large part, this is a public relations problem. Consortiums that share health records may want to make it clear to patients exactly who has access to their records. Confidentiality is simply more difficult to maintain in small communities, and often more important to the health system users.

  5. Hayward Zwerling, M.D. Says:

    There are many award winning, inexpensive and comprehensive EMRs, which have been created by physicians. Unfortunately, the expense of CCHIT certification has succeeded in increasing the visibility of the most expensive EMRs while burying these highly functitonal and less expensive EMR under the smoke screen of CCHIT mandated bloat.

    Hayward Zwerling, M.D., FACP, FACE
    ComChart Medical Software
    275 Varnum Avenue, Suite 102
    Lowell, MA USA 01854
    fax: 978/656-9950
    mobile: 978/407-0101

  6. Amy C Says:

    HELLO - Provacy. Can you guarantee it? If not, keep my imedical info on paper. Thank you.

  7. deepz Says:

    Just as JCAHO confuses the quality of the hospital paperwork with quality of patient care — they are NOT the same thing — so does your editorial. I work with EHRs on a regular basis. Yes, they contribute to accessibility between providers, but they are no panacea.

  8. David Harlow Says:

    A couple of comments:

    1. Having been privy to a couple of EHR rollouts, I agree with Michael’s point that it’s all about implementation. Docs need to be prepped in advance, and given appropriate support during the rollout. There will be fewer patients seen, and an attendant dip in revenue, duroing the rollout period of a few months.

    2. To follow up on Vijay’s point — yes, the cost is the providers’ and the benefit is the payors’. The benefits also accrue to malpractice insurance companies, who can end up as free riders. So here in Massachusetts, there is now a program whereby docs with EHR systems can get a break on their malpractice insurance premiums, thus providing a timely financial benefit for the costs and headaches endured by docs while adopting an EHR system. For more detail on the malpractice insurance deal, see Micky Tripathi’s MAEHC blog:

  9. Chronicles of Dissent Says:

    […] on Epidemix, Thomas Goetz has a blog entry, “The Other Upside to Electronic Health Records,” that is a companion piece to his op-ed in the NY Times on the use of electronic health […]

  10. Mark Says:

    In your editorial, you seem to advocate a ‘national standard’ EHR. At first glance this may seem desirable but it’s impossible to implement. A better solution is to have national standards for information interchange so that different programs can share information.

  11. Timothy Fischer Says:

    I agree with many points you have made in your article. I would also like to let you know that one of the biggest issues with moving to an EMR is data that resides outside the digital reach of each EMR, whether it was created previous to implementation or at a non-linked site. eHealth Global Technologies ( has recently launched a service in a number of facilities where we will retrieve those previous and outside records and provide them to our customers either through their EMR or through a hosted solution.

  12. Marlon Williams Says:

    The introduction of WorldVistA was a terrible decision that is only confusing the market. A lot of people are wasting their time and efforts on a system that is as antiquated as the first PC. See my article about this at

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