Do the simple stuff first is Klepper's Law
My first post of this year quoted a piece written by David Kibbe and Brian Klepper (right), attacking EHRs.
Yesterday Dr. Klepper was kind enough to follow up with a phone call.
The piece shocked EHR advocates because Klepper is one himself. His clinics not only have complete medical records on patients, but have best care guidelines embedded into those records.
It's the care guidelines, rather than the EHRs, which hold the key to reform, he told me.
Simple in this case refers to economically simple. The computing here is a massive undertaking.
"There's a six-fold difference in cost between doctors to obtain the identical outcome," he said. Raw computing power, crunching case studies to learn what works best, can narrow that cost gap.
"The most exciting stuff happening is in decision support," he said, because that's where the advantages of Moore's Law can be brought to bear.
Use rules to drive algorithms to drive decisions. Once you write the rule, create a jury and let anyone challenge the rules only if they bring evidence.
It's an expert consensus based system you want to attach to the back of every EMR that will tell a doctor what to do, based on historical claims data.
It's made possible by advancing computational power and the Web.
An example is the work being done by the Consortium of Southeastern Hypertension Control (CoSHEC CoSEHC) .
"It's made up of propeller heads and preventive cardiologists who think about cardiovascular metabolism. They have a deep understanding way beyond anyone else. And look at how they manage their patients – spectacular."
Dr. Klepper's criticism of EHRs (which continued yesterday) is not just about the technology, which is incompatible and expensive, but about the priority.
"The biggest bang for your dollar is in analysis and decision support based on existing data," he concluded. But I hope we will talk again.