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Electronic Health Records, Medical Liability

Medicine is no stranger to the technological cutting edge. In many respects, it’s been a great innovator and adopter of new technologies. But when it comes to record keeping, the medical industry is still in the dark ages. While other industries have long gone digital, the bulk of record keeping in U.S. hospitals is still being done on paper. Harvard researcher Ashish Jha has published a troubling progress report about electronic health record adoption rates. On today’s show, we talk with Dr. Jha about what’s taking medicine so long to go digital – and what the delay means for patient safety. And later in the show, Jha’s colleague at the Harvard School of Public Health, Michelle Mello, puts a dollar figure on a politically divisive area of medicine: medical liability and defensive medicine spending.

Listen to this episode.

Segment 1: Abysmal Adoption Rates for Electronic Health Records
Guest: Dr. Ashish Jha

Bio: Dr. Jha is an associate professor of health policy and management at the Harvard School of Public Health. He is also a practicing general internist and a senior adviser to the under secretary for Health at the Veterans Administration. He co-authored the recent progress report on Electronic Health Records that was published in Health Affairs.


Is there any aspect of our lives that hasn't gone digital? Many of us carry around weeks' worth of entertainment on portable devices that fit in a purse or a pocket; we communicate almost exclusively by e-mail, text, and cell phone; even our most private transactions are done online: shopping, banking, stock trading.

So what's the big deal with electronic health records? Is the health care industry really so far behind the rest of the world in making the digital transition?

According to a recently published progress report, the answer is a definitive "yes." According to the report, only 12 percent of U.S. hospitals had adopted basic electronic health records by the end of 2009. Next year, the federal government will start awarding 27 billion dollars in incentives that promote electronic health record (or EHR) adoption and usage. But that 27 billion dollars will only be distributed to hospitals that meet "meaningful use" requirements - that is electronic health record usage that achieves significant improvements in care. According to that same progress report, less than 2 percent - yes, 2 percent - of US hospitals currently meet these standards.

Segment 2: The Cost of the Medical Liability System

Guest: Dr. Michelle Mello

Bio: Professor of law and public health at the Harvard School of Public Health. Dr. Mello was the lead author of "National Costs of the Medical Liability System," published recently in Health Affairs.

The political battle over health reform was fought on many fronts - among them, the country's costly medical liability system. Estimates about the costs of medical liability have varied widely, specifically the cost of doctors practicing defensive medicine. Some have placed the cost in the hundreds of billions of dollars, approaching 20 percent or more of total health care spending. A recent report published in Health Affairs puts the cost of medical liability closer to two and a half percent. But even that figure would amount to an estimated $55 billion spent every year on medical liability, $46 billion of which is being spent on defensive medicine - unnecessary tests and procedures prescribed by doctors in an effort to avoid lawsuits. Democrats and Republicans disagree about the best way to curb defensive medicine spending, with most Republicans - and physicians - favoring tort reform like caps on damages.

Dr. Michelle Mello is the lead author of the recent study that appeared in Health Affairs. She's described the medical malpractice system as "deeply flawed," but has also questioned the emphasis on tort reform as the best solution to the problem.