Underlying all the questions about health IT is the question of who should pay for it. (Evil lawyer from the blog GlobalPOV.)
Hospitals and insurers currently foot the bill. They do this for the same reason other businesses do -- to gain greater control of the operations, to cut costs.
Doctors in medical offices don't gain as many benefits, because their operations are smaller. There is a disconnect between who bears the cost of IT and who gains the benefits.
But there's another, deeper problem. Fear.
Many doctors fear automation because documentation invites lawyers. As one correspondent put it:
The Democrats love it because it will make it much easier to sue physicians.
Auditing care will find mistakes, and mistakes will lead to lawsuits. Mistakes are inevitable, however, so don't put anything down and maybe no one will be able to find out.
This same attitude exists throughout society. It's one reason President-elect Obama was told to give up his Blackberry.
Thus the real fear rears its head. Transparency. We are all afraid of transparency, assuming that others won't be willing to see the difference between honest mistakes and real malice.
The assumption is lawyers and journalists won't let us.
We should. Some medical mistakes are just mistakes. A few are ethical violations, to be dealt with through ethical means. And an even smaller number involve true venality, real criminal conduct.
How do we tell the difference in medicine so as to enable health IT reforms to go forward? If doctors truly saved time and money by supporting EHRs, many more would buy them. My personal view is punitive damages should be very tough to prove, but uninsurable, capable of driving people under.
Real damages should be accepted, ethics should determine how many are too many, and compensation should follow a regular schedule.
Why can't this happen? Cynicism and greed. Journalists assume the worst in others because it's good copy, and lawyers do because it's profitable. The response by doctors is to demand the lawyer's profit be stripped away, leaving the real baddies free to prey upon us.
Accepting honest mistakes, and understanding the vast gulf between that and truly Blagojevichian activity, would go a long way toward getting all stakeholders to accept the need for automation. A little forgiveness would go a long way.
As would linking the costs of documentation to the benefits. If doctors truly saved time and money by supporting EHRs, many more would buy them.