The System

Bill Gardner at Something Not Unlike Research notes that Canada actually has a lot less information technology than we do and much less adoption of EMRs. This is curious, since we’ve been all told about the importance of EMRs to bending the cost curve in the right direction while improving care. Gardner hits upon the reason why this hasn’t manifested itself in explaining why Canada doesn’t have extremely high adoption rates: “A lot of US health care information technology investments are devoted to managing the pathologies of billing multiple insurers for care. Billing is simple [in Canada].”

Of course this just goes to a point I’ve made before that the usefulness of a particular technology depends on the system it’s embedded in. In a system that values fee-for-service overuse, we’ll see EMRs bent to solving billing codes and trying to microtarget advertising to patients to get them to purchase care they might not otherwise have. A system that doesn’t will try and use it to reduce tests, duplicative drugs, etc.