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Originally Posted At: http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/111571956892830.xml&coll=7&thispage=1

Cost, image worries hamper data on doctor care
A survey finds physicians are hesitant to use electronic records that would show the total and types of mistakes
Tuesday, May 10, 2005
ANDY DWORKIN
The Oregonian

Only one-third of doctors get regular, unbiased data about the quality of care they provide. And many wouldn't share the information with patients if they had it, a survey of 1,800 U.S. doctors says.

The study, published today in Health Affairs, found U.S. physicians slow to adopt electronic records that can show the numbers and kinds of mistakes they make.

Better records might stop thousands of fatal medical errors. But cost and worries about their image discourage doctors from those improvements, health researchers say.

Patient-care records can spotlight doctors with a history of harming patients, such as surgeon Jayant M. Patel, who practiced for more than a decade in Portland before the state disciplined him in 2000 for "gross or repeated acts of negligence." Patel, cited in 1998 by then-employer Kaiser Permanente, is under investigation for errors at an Australian hospital where he worked the past two years.

Good statistics are also vital for finding subtle patterns of errors from miscommunication or oversights, such as lab results that aren't reported to patients. Many doctors say such systemic errors are more common and deadly than negligent care.

Oregon comparison unclear

How Oregon would compare with the U.S. survey isn't clear.

On one hand, researchers found that doctors in small groups or solo practice are far less likely to have electronic records. And Oregon has "a significant number of physicians -- I suspect in the whole state, close to a majority -- that are still practicing in small groups or solo," said James Kronenberg, chief operating officer of the Oregon Medical Association.

However, many Oregon doctors contract with health insurers that annually review patient charts to ensure that physicians meet care standards, Kronenberg said. He said the OMA has done many of those checks for insurers since 1994 and shares the data with doctors. The group does not yet provide "benchmark" information on how other doctors compare, he said, but hopes to start soon.

Nationwide, the survey found that just one-quarter of doctors computerize medical records. Just one-third of doctors regularly see data on outcomes, from patient surveys or records that track the use of safety procedures or treatment results.

Electronic records are vital because health care has grown "too complicated" to track with memory and paper charts, said Dr. Anne-Marie Audet, the study's main author and assistant vice president at The Commonwealth Fund, which sponsored the survey.

Computerized records systems are expensive, she said, but "there's also some cultural component" behind resistance to adopting the systems. Doctors are rewarded more for productivity than quality of care.

"We have to figure out ways to remove the disincentives to quality," Audet said.

Little sharing with public

Secrecy also seems cultural: More than two-thirds of doctors said they would not share quality-of-care data with the general public, and 44 percent didn't want to tell their own patients.

Audet said patients should ask doctors about their safety procedures and success rates, to encourage better reporting. She acknowledged that poorly reported data could unfairly make doctors who treat sicker patients look worse than peers. But good systems account for those differences, she said.

Statistics on individuals can be uncertain if the doctors treat few patients a year, said Dr. R. Adams Dudley, a health-quality expert at the University of California at San Francisco. However, doctors can measure whether they follow certain safety procedures, he said, and hospitals can track both procedures and success rates.

Although the initial investment for electronic records is high, Dudley said care providers "need to bite the bullet."

"I think if we measured things . . . you could save thousands of lives," he said. "So why isn't it done? . . . Getting people to invest money in the short term is difficult."

Andy Dworkin: 503-221-8239; andydworkin@news.oregonian.com

2005 The Oregonian

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