In a way, cost is perhaps the least of our troubles with the electronic medical record. It is an instrument to be used for the care of the patient. We are not debating whether the electronic medical records’ benefits are proportionate to its cost. Rather, we are contemplating what a dense and interconnected mess it has made of medical record-keeping. electronic medical records are never constructed for their utility in keeping the physician on-point in the consideration of the patient. Not one of them, that I’m aware of.
To some degree, they serve a nefarious purpose in putting billing and coding ahead of analysis and treatment. But even more troubling, they exist for the preservation of bad assumptions and illogical premises in healthcare. These can be neatly bundled under the term “superstition.” Our planning for the future of healthcare seems to me little different from the heavy weight of cruel and burdensome religions that have led to the collapse of societies that have been unable to throw them off.
The superstition of old was of the Philosopher King. All we need to do is place the best and wisest person in absolute command of our government, and all good things will flow therefrom. The heartbreak of the various attempts at this over the past few millennia is that we do not become led by the best and wisest; we become led by those with the greatest avarice for power, and not even those whose intelligence and skill in government is comparable to their greed for power. This is the heartbreak of Socialism. It is a worthy idea in principle to run our economies scientifically. However, we lack the persons of such great character who might do so.
Instead, we have the Robot King. We shall design the best and wisest algorithms that will rule us. None of the baser instincts of greed will be written into the algorithm. It takes little to understand that the Robot King is as pitiful a superstition as the Philosopher King.
We are willing to pay in the currency of human lives, sacrifices to the myth that the electronic medical record has some general and great benefit. I haven’t seen it.
Take only the matter of the Problem List. A machine for textual record-keeping should be able to index itself automatically according to certain categories, to make the location and retrieval of information easier. One’s operating system does that for files on the computer, seeking keywords. However, after several decades of EMR’s existence, none seems designed for the facile interlinking of these texts by topic. Rather, the record has expanded the amount of dreck that is filed, like a genome gone awry with the reduplication of junk DNA. The message becomes buried in the mass of garbage.
If this electronic medical record cannot make it easier to pinpoint the history of a certain problem, but instead makes it many times harder, then critical facts become lost. And in medicine, the loss of facts leads to the loss of lives.
I am no more willing to allow the electronic medical record makers the benefit of the doubt, than the British were willing to allow their Government the benefit of the doubt in the planning and management of the Iraq War (look up the Chilcot Report for more information.) How much failure might we shrug off in the creation of this information machine that degrades but does not enhance the quality of medical care?