Law of Unintended Consequences

Gary Baldwin, for HealthLeaders News , September 18, 2007

This editorial in the Boston Globe offers a key perspective. Even though he's pro-technology, a physician laments how using an EMR can impinge on the doctor-patient relationship. "Despite repositioning the computer in every imaginable way, I often find myself making more eye contact with the screen than I do with my patients. It is simply more difficult to face a patient while typing than while writing," says Michael Hochman, MD, a resident at the Cambridge Health Alliance.

This is a common, but little discussed aspect of incorporating technology into the clinical setting. Everyone raves about the efficiency, added safety, and increased savings of automation. But the unintended consequences of technology rarely get aired out. Sometimes they are financial.

Put in a messaging system, for example, and suddenly you have created a need for a database to compile all the messages. Add an interface to an existing system, and suddenly you have created a hidden cost center--when the other system is upgraded, the interface may no longer work, thus requiring additional labor. Eliminating transcription costs is a plus, but practices may have to implement--and train physicians to use--voice recognition software.

Hochman's essay touches on what might be called the unintentional "workflow" issues around technology. The problem may not show up on a balance sheet, but it will affect the quality of care delivery. Perhaps the best example is when physicians figure out the "copy and forward" function of the EMR. Basically, physicians just select portions of a previous encounter and paste into the current documentation screen.

They may figure that since little has changed, why not? But the practice can wreak havoc on the billing department, when it comes time to figure out exactly what services were rendered.In the January issue of HealthLeaders magazine, I will be tackling some of the "hidden costs" of EMR technology. It is technology laden with trade-offs. If you have any thoughts on the subject, send me an e-mail.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at




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