A Medical Device Daily
If it upsets you that your doctor fails to do cartwheels when you say, "I know my body," be grateful you're not a computer. A recent report on the outpatient use of electronic health records (EHRs) indicates that EHRs apparently don't help doctors know your body, either.
According to a study just released by researchers at Stanford University School of Medicine (Stanford, California) and Harvard School of Medicine (Boston), the use of EHRs registered no gain in the quality of care in 14 of 17 measures.
The resulting paper, published in the July 9 edition of the Archives of Internal Medicine, reported that EHRs "were used in 18% … of the estimated 1.8 billion ambulatory visits in the United States in 2003 and 2004," but that "EHRs were not associated with better quality ambulatory care."
Of the three remaining measures, one fared worse, namely the prescribing of statins for patients with high cholesterol levels. The remaining two — avoidance of needless urinalyses during routine exams and reduced prescribing of benzodiazepines in depressed patients — improved in association with use of EHRs.
Randall Stafford, MD, one of the authors of the paper, recommended caution for those who assume that EHRS "are going to solve problems around healthcare quality by themselves."
He added that doctors, known for having stiff necks, must be willing to take the information under advisement and "act on that input."
The study drew on data collected as part of the National Ambulatory Medical Care Survey during 2003 and 2004.
Stafford said that some of the software used for EHRs in use in 2003 and 2004 offered nothing more than patient data, but more recent iterations offer more robust information, such as suggestions for medications or tests.
All the same, Stafford said that "[w]e're still on a learning curve in terms of how physicians relate to electronic media."
A generational effect is seen in that "recent graduates of medical school are clearly more comfortable with these technologies, and it's only gradually diffusing into the whole of the medical practitioner population," he said.
Included in the 14 quality indicators that exhibited no change from paper to bytes were the prescribing of recommended antibiotics, diet and exercise counseling for high-risk adults, screening tests and the avoidance of potentially inappropriate prescriptions for elderly patients.
Bush nominee in crossfire
Another Senate battle is brewing over another Bush nominee for a top federal post, that of James Holsinger, MD, for U.S. surgeon general. But this time, antipathy is coming from both ends of the political spectrum.
On the left, the Planned Parenthood Federation of America (New York) objected to the nomination. And National Public Radio, prior to last Holziner's appearance last Thursday before the Senate Health, Education, Labor and Pensions committee, stood outside the Dirksen building and "chanted slogans about how the job has become politicized."
However, the same complaint was strongly suggested by those on the right, with the Family Research Council (FRC), objecting to Holsinger's position on cloning and embryonic stem cell research.
According to a report by the Washington Times, Tom McCluskey, VP for government affairs at FRC, said that the organization is concerned about testimony that Holsinger gave before a Kentucky state legislature committee in 2002, during which he apparently advocated "loosening regulations around cloning and embryonic-stem-cell research."
"We're not supportive of his nomination right now," McCluskey said.
Then there are the complaints from gay advocacy groups, that cite a paper Holsinger wrote in 1991 for the United Methodist Church on homosexuality, concluding that the sexual practices of gay men were detrimental to physical health.
As a member of the UMC Judicial Council, Holsinger voted in 2005 for a majority 6-3 ruling that Elizabeth Stroud should be removed from her post as the pastor of a UMC church in Germantown, Pennsylvania. Holsinger, however, described his vote as a "jurisdictional matter," pointing to UMC's General Conference as the body authorized to change the church's position on same-sex relations.
It is not known yet whether Ted Kennedy (D-Massachusetts), chairman of the HELP committee, intends to proceed to a nomination prior to the August recess.
In a related development, Kennedy has authored a new bill that would use the Institute of Medicine (IOM; Washington) as a source for nominees to the surgeon general post in an effort to "ensure that sound science is not trumped by politics in the Office of Surgeon General."
(In a demonstration of the power of the proofreader, an earlier version of the press statement had said that he wanted to "ensure that politics was not trumped by sound science.")
The bill comes in response to testimony by outgoing Surgeon General Richard Carmona, MD, and two other former holders of the office at a recent hearing of the House Oversight and Government Reform Committee.
Carmona complained about interference by Bush administration officials regarding, among other things, the effects of second-hand smoke.
David Satcher, MD, who held the job under President Bill Clinton, told the committee that members of the executive branch had tried to prevent him from issuing a report that indicated that needle-exchange programs had shown efficacy in reducing disease transmission among addicts. Satcher released the report despite the pressure.
C. Everett Koop, MD, a Reagan appointee, also released a report, one that addressed AIDS, in the face of pressure of similar origin.
The three former surgeons general were united in their view that the selection process should be changed, as should the means of financing the office's operations.
The press statement mentions the testimony of Carmona, but not of Satcher or Koop, and blasts what it described as "a morass of shameful political manipulation and distortion of science."
The bill would allow the office to submit its own budget request to the White House and Congress and would forbid "any attempt to censor the work of the Surgeon General for any reason."