What Did He Expect?
Michael Millenson on the government’s attempt to get everyone to use electronic health records:
Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; absurd flaws — a medical record less searchable than a ten-year-old PC ― that were never corrected while piled-on new features created a kluge-job catastrophe.
Then there were the unintended consequences that occur when any innovation is taken to scale. Is it any surprise that academics focusing on efficiency and clinical improvement were blindsided by sharpies who focused, instead, on how EHRs could help game the reimbursement system to make more money? Is it a surprise that a new technology deployed in a hurry can be downright dangerous as well as helpful? Unfortunately, painting a picture of a panacea was useful for public relations purposes, but prompted a widespread backlash when reality set in.
I encourage people to go to the linked article and read the comments. Many of us were predicting the top-down imposition of the HITECH Act would fail as badly as Britain’s similar attempt (which wasted $12 billion before it was shut down.)
It’s still appalling to me to think of how dated and inefficient the system of tracking records is in our system, but unfortunately, that’s not the only thing that is inefficient and broken.
Right, I am not sure what anyone really expected from this failed intervention to try to publicize medical electronic records, especially under an already broken and messy health care system.
The VHA has maintained 5.3 million EHRs for the past 5 years, despite the fact that they treated more than 6 million unique patients in 2012. Only 9.5 percent of redundant information is shareable throughout the entire system, and it is incapable of communicating with the DoD.
Yeah, the man knows how to do EHRs. Pfft.
Most younger clinicians love the system, but a lot of the older ones say that they receive too much information, to the point where it is distracting. Jack’s correct, and what he didn’t mention is that physicians just copy/paste data over and over, it ultimately increases patient/provider error.
Never trust an NCPA excerpt, always read the entire article. Here’s what you’ll learn if you don’t trust their biased reporting “The actual scandal is more complicated and scary. It has to do with the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence”
diogenes, you are blaming the wrong people. Blame the government.
Every time a small practice tried to electronically communicate with labs, hospitals etc. the Stark Laws intervened and made many of these efforts illegal because equipment or personal were being shared. Those laws applied in such a dumb fashion I believe might have been one of the biggest inhibitors to the development of EMR’s. One can look at the physician as a business and a consumer. To meet the needs for the development of EMR’s the physician needed capital and skilled workers something few small groups of physicians had in sufficient quantities. However, many of the companies they dealt with had the money, the desire and the knowledge to link up with physicians and develop more efficient systems. Instead of doing so the Stark Laws forced older technologies to be used in offices that could not afford the capital outlays or the staff.
Today the government is spending taxpayer money to do the same thing everyone wanted to do at their own costs decades ago. The list of government interference in the advancement of IT is tremendous. Start blaming the right entities.
“physicians simply refused to believe they could benefit from an EHR”
“all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians”
Why is it that so many reporting on HIT issues continue to fail to link the first statement with the second.
Dr. Mike, you are absolutely correct. When I installed EHRs, I would swoon any time an MD actually took the time to go over some workflows. The nurses, lab supervisors, case managers, materials management, bed planning, billing, reporting, and anyone who WASN’T a doctor would show up to my meetings and give me feedback. When the doctors would complain about the workflows at implementation, I would point them to the nurses or the surgery schedulers. All of their workflows were easy and intuitive. The doctors’ workflows were not – because they were too important to spend the time during the install phase to get the software set up correctly.
Part of the problem is that the government scares away high quality tech entrepreneurs and investors from tackling healthcare related software like this. They would rather put their effort into niches that are likely to remain free markets than take the risk government intervention will undermine any business they start.
There has been a perception for years the government might come in and set rules that would make a product obsolete, perhaps in favor of the approach a politically connected vendor takes, or pushing a government takeover to impose software the government creates (or contracts to create).
Even if they feel they can get away with building a business over say 5-10 years, they need to know they will be able to cash out then, which means those buying the company later will need to perceive it will continue to be profitable in the future, e.g. over the next 5-10 years.
For more details on how government messes up the healthcare system in ways many don’t realize (including at least one Dr. Goodman has never commented on re: MLRs) see this new page:
http://www.politicsdebunked.com/article-list/healthcare
Clever, Gabriel. You do have a point, to a point. But to equate what a doctor needs out of an EHR to what a nurse or scheduler needs out of an EHR shows a fundamental misunderstanding of the physicians role in health care.
In terms of the situations where the doctor is the one benefitting from the incentive instead of their employer, it is rarely true that the doctor has any input on the workflow even if they wanted to. Some of the benefits of EHRs are actual benefits. Some of the negatives of EHRs are just as real. There are in every instance difficult interfaces and missing functionality that make it less likely that the physician will ever realize the true potential of what an EHR could make possible.