Want Electronic Medical Records? Fix the Incentives

Suppose you are traveling, and needed to visit a doctor, who says he'd like to do an MRI. You had one done just two weeks ago at home, but your personal doc would have to snail mail the image to the new doc. The new doc needs to have a look inside you, but another MRI would be expensive.

Now think: in what kind of health care system are you more likely to get electronic medical records, where doctors can send MRI results to each other instantly:

• A health care system where you are on the hook for the cost of the second, unnecessary MRI, or
• A system where someone else (Medicare, your employer, etc.) is going to pay for it?

Thanks to government subsidies and the federal tax code, Americans are less sensitive to the price of medical care than even Canadians, whose government is supposed to pay for everything. As a result, most providers still keep patients' medical records on paper, essentially because the government lets them get away with it. Some providers have started using electronic medical records, but those systems are in their infancy and are unable to talk to each other. That means lots of wasteful spending, plus treatment delays and medical errors.

When Katrina hit Louisiana, thousands (millions?) of medical records were destroyed. But when the World Trade Center went down in a fiery blaze, there was no hue and cry about the loss of financial records, because those were secured, electronically, in various sites. Why the asymmetry? My guess is that the financial services industry has customers who demand value, including responsiveness and security, because they bear the cost. Health care providers that do have price-sensitive customers, such as services like MinuteClinic and TelaDoc, do offer electronic medical records. But most of the health care industry does not have price-sensitive customers, and we have Congress to thank for that.

So when House Republicans plan to vote this week on legislation that would spend your tax dollars to encourage the creation of electronic medical records, it seems like a classic case of one fouled-up government intervention begetting another. Congress has spent the last 60 years doing little in health policy but insulating patients from the costs of paper medical records. But don't worry, because now they're going to throw $40 million of the taxpayers' money at health information technologies (HIT) that create interoperable medical records.

In a further demonstration that Congress is wasting its time (isn't there a war on?), this week Microsoft announced plans to start producing interoperable electronic medical records. Maybe the fact that the private sector is trying to muster to the task -- in spite of Congress' past meddling -- will persuade Congress not to compound its past mistakes. Perhaps Congress will instead look at ways to restore the incentives that encourage providers to offer such cost-saving innovations. One can always hope.