Why doesn’t America have electronic medical records?

Ezra Klein poses the question:

I’ve never read a compelling explanation of why the nation’s doctors and hospitals haven’t broadly adopted electronic medical records.  It’s not as if they’re allergic to technology.  At this point, cardiovascular care employs every strategy but astral projection to keep our in rhythm.  It’s not as if it wouldn’t be cheaper and easier for them.  The man hours and costs from keeping track of files, printing out labels, finding lost manila folders, and getting sued because the nurse misread the doctor’s handwriting are enormous.  Theoretically, insurers should be pushing on this, but they seem behind the curve, too.  And it’s not as if there aren’t tested programs in use — not only does Europe do electronic records well, but the VA does them beautifully, and they’ve released their primary program, ViSTA, as open source, for free use by anybody.

I can think of four reasons. 

1. Most of the benefits are reaped by the patient, and in the long run.  Today’s suppliers don’t realize these benefits in the form of profits.

2. The United States has relatively weak data protection laws.  Many people don’t want outsiders to know their medical history, and information compilers fear lawsuits if the information leaks out or is hacked.

3. No single provider has an incentive to move first in this game.  Why computerize if no one else has?

4. I haven’t computerized my office (is Alex laughing?), I worry more about surviving until the next day.

The comments over at Ezra’s are excellent.  And if you think that electronic records are the source of vast productivity gains, just have Medicare mandate such a change.  Readers?

Addendum: Here is Arnold Kling.