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Editorial: From Paper to Computer; Assessing Change in Health Records

It was disruptive, painful and expensive. But there was a good reason why hospitals and health care providers were pushed to convert to electronic medical records: The switch promised to make the nation’s health care system more efficient. A 2005 Rand Corp. report predicted that $81 billion would be saved annually by moving record-keeping from paper to computers.

Eight years and billions of dollars of investment later, Rand decided to see how it’s working out.

Not very well, at least in terms of savings. If anything, some analysts now fear, the conversion to electronic records might be driving health care costs higher by making it easier for providers to bill for services, sometimes for care not actually delivered.

Not that the advocates are willing to concede they were mistaken. They say the potential for significant savings remains — that once changes are made to better allow different systems to communicate with each other and also make it easier for health care providers to use the technology, the digital switch should prove a worthwhile investment.

We hope so. The federal government spent billions, mostly in stimulus money, creating incentives for hospitals to make the conversion. Judging by the experience at Dartmouth-Hitchcock Medical Center, it wasn’t a pleasant experience — for providers or patients. Coping with the training, the unfamiliarity, the glitches and the backups created during the switch-over tested the patience of many.

The assumption, though, was that the ability to instantaneously access patient information would streamline health care delivery, reduce duplication and cut down on errors. But health care providers are still waiting for the payoff.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” Dr. Arthur L. Kellermann, one of the authors of the new Rand study, told The New York Times.

The Times provided some context that is particularly interesting now that the move to electronic records has proven a disappointment, at least in the short term. The original Rand study that forecast tens of billions of dollars in savings was funded by several companies that have since profited handsomely from the conversion. The Cerner Corp., for example, a developer and seller of records-management systems, has nearly tripled its revenue — to $3 billion — in the eight years since the publication of the report it helped finance.

Meanwhile, there’s ample anecdotal evidence that the change has not been well received by some in the medical community. Some doctors dislike the amount of time the new technology demands — time they might otherwise spend talking with and listening to patients, which presumably is when the information most crucial to the practice of good medicine is shared.

And even if the electronic record-keeping eventually delivers on its promise of being a useful tool in improving the delivery of health care and lowering its cost, it’s hard to ignore the obvious danger of storing all that sensitive personal information on computers — the potential that security systems will be breached and the private information will fall into unauthorized hands. No doubt, the designers of the systems have taken pains to guard against that happening, but so did numerous other industries and agencies that handle confidential information — only to discover that those barriers weren’t impervious to hackers or human error.

It’s perhaps too early to proclaim the switch to electronic records a failure, but it wouldn’t be premature to use its bumpy beginning as a cautionary tale. As the need to bring down health care spending becomes ever more pressing — the total has climbed by $800 billion since the 2005 Rand study came out — the temptation to embrace change and perhaps overestimate its value will increase commensurately. Tolerance for reform and the difficulties entailed in altering course are essential, but so is a healthy dose of skepticism.