Wednesday, February 23, 2005

Government sponsored EMR?

An argument for and against. As I have commented before, Medviews frequently writes in favor of government intervention. My view is that the marketplace will determine what is best.

For the best I've read on the weakness of government dictation of market issues, see Thomas Sowell.

Let's imagine an issue, which can remain undefined, on which the government has knowledge worth 2 million. Now imagine that ten percent of the US population each has knowledge worth one. Obviously the government has vastly more knowledge than any individual. However, the population as a whole has vastly more knowledge than the government.

For example, what if the government were tasked to decide what type of fertilizer we should use on our lawns and how much and how often. I'm sure the resources of the government could create an awesome panel with incredible horticulture experts that know more about fertilizer than any of us. This panel would be tasked with determining what types of fertilizers would be produced, in what quantitites and where the fertilizers would be distributed.

What the panel couldn't know is the individual preferences for what we want from our lawns, what we want to use them for and what we want them to look like. Also, imagine all the different types of soil, climate, etc. Allowing the marketplace to dictate the manufacture and distribution is vastly more effective. Just ask the farmers in the former USSR. The fields in the lands of the former USSR were very productive prior to central control but were devestated by central control of resources, including fertilizer.

There is no way that central control can understand the multitude of issues the way that the population at large can.

In the case of EMR, Dr. Henochowicz is concerned that there could be an electronic tower of Babel:
There are at present about 1800 different EMR systems on the market. Which do you choose? Which companies providing the product will still be in business 2 years from now? How will all the EMR systems talk to each other? Will we truly have an integrated nationwide network where patient information can transferred from one system to another?
His solution?
We need to have a coordinated, government led effort to get practices to go electronic. Subsidies need to be allocated on a means tested basis. Clinics that provide care to the indigent need more support than Park Avenue physicians. We also need to establish a uniform standard for EMRs. This was done with the internet through the designation of html as the standard mode of communication. The VA system has been suggested as the model for this standardization. This is a great idea, and government should get all the important players in the private sector together to make this happen.
I don't recall that the government was involved in specifying html as the standard for the web. When was the last time anyone thought the VA system worth emulating?

I agree with Dr. Henochowicz that it would be better if EMR's could communicate. Those of us who are old enough remember BetaMax vs VHS. This was resovled without goverment intervention. What about the standards for CD-ROM, DVD's and audio CD's. No goverment intervention there, but any one of us could trade DVD's (within regions) without trouble.

Trent McBride wrote:
It's ridiculous to think that 1 million physicians across this country, caring for 250 million people, can come up with one, and only one, set of standards and regulations to usher in a project that will cost tens of billions of dollars. Even assuming that this were possible, it's a horrible idea. The best EMRs will result from simultaneous systems running in parallel across the country, with trial and error finding out what works and what doesn't. It's ludicrous, and downright dangerous, to believe that physicians as a collective have the knowledge to know in foresight what will constitute the best set of standards for everyone's EMR.

If you allow the marketplace to dictate the results, over time a few dominant systems will emerge and will create a standard. Be patient. For Heaven's sake, don't invite the government in.