A colleague of mine told me about an Oklahoma City area hospital that just introduced their electronic medical records system.  At first glance, the inefficiencies that these systems introduce are annoying and surprising.  Take for instance, the emergency room.  The head of the E.R. told the hospital administration that one of the metrics they follow as a contracted group of E.R. physicians is their “walk out rate.”  This the rate at which patients, once checked in at the E.R., simply leave, having waited longer than they were willing to wait to be seen.  Since this hospital opened, their walkout rate was no more than 3 patients/year.  This is quite an accomplishment.  The first weekend the EMR was activated, 9 patients walked out due to the increased wait times associated with the system.  Now you are saying,”Hey, that’s not fair!  The system is new!  Once they get their act together, it will be more efficient.”

Not so.  Facilities that have adopted these systems have found that the opposite is the case.  Inefficiencies having been introduced into the system inclines the working staff to harbor the notion that nobody at the top cares about efficiency and waste, so why should they?  This is indeed what has happened.  The old rolling snowball.

Enough of our first glance.  Taking a closer look makes it clear that the EMR will be used as a rationing tool.  Emergency rooms can’t see as many patients if they have to wait longer.  Surgeons can’t operate on as many patients if the operating experience is a 40% longer experience.  Rather than have surgery next Wednesday, surgery will be 3 weeks from Friday.  You don’t think anyone will die waiting, do you?  Hospitals, of course, will figure out a way to charge more for doing less.  More on this in my next blog.

G. Keith Smith, M.D.