Doctors and Computers
by John Goodman

In Australia, 8 of every 10 doctors keep patient records electronically. In New Zealand and Britain, the figure is 9 in 10. In the Netherlands, almost every doctor uses electronic medical records (EMRs). Yet in the US, the figure is less than 1 in 4. Only Canada scores worse. So says a recent Commonwealth Foundation report.

It gets worse. In other countries doctors are more likely to be able to order prescriptions electronically, to get computerized alerts about potentially harmful drug interactions, and to get computerized prompts to send patients test results or notices about preventive or follow-up care.

So why are US doctors falling behind? The short answer is because doctors in other countries get financial rewards for using computers and our doctors don't. But why are other country's reward systems better?

In some press reports, the words "centralized" and "public" are contrasted with US system descriptors: "decentralized" and "private." Centralization clearly changes incentives. Since the VA system and Kaiser are directly responsible for all patient health care costs, they gain more from information technology than independent hospitals, private practice physicians and garden variety private insurers.

But if socialism were the answer, why does Canada (the ideal for single-payer advocates) score worse than we do? Also, in its summaries and press releases, Commonwealth cherry picks its results.

Over all measures, the UK comes out on top for the use of computerized systems (probably owing to the 50% increase in the NHS budget under Tony Blair). But British doctors are as likely as US doctors to have to repeat a test or procedure because the findings are unavailable or to discover the patient's medical records are unavailable at the time of a patient visit.

Even with their computerized systems, British doctors are three times more likely than US doctors to experience problems because care is not well coordinated across multiple sites or specialties. Also, British patients are 6 times as likely as US patients to experience long waits for diagnostic tests and 7 times more likely to experience long waits for surgery. (On waiting times, patients in most of the other countries also fare much worse than US patients.)

Long before doctors in any of these countries were using computers, lawyers had all their client records stored electronically. Ditto for accountants. And engineers. And architects. And virtually every other professional.

We don't need socialism to bring doctors into the 21st century. We need markets.

John Goodman is president of the National Center for Policy Analysis. His full article can be read here.