Despite Incentives, Doctors’ Offices Lag On Digital Records

To know the true reality of yourself, you must be aware not only of your conscious thought, but also of your unconscious prejudices and biases.

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January 23, 2013 - I’ve been accused of being biased against digiital records. Among physicians, of this I’m not alone. EHRs, say physicians, cost too much, make them less efficient , invade the private space between them and their patients, and do not tell the patient’s story. Like all stories, as indicated in this piece from Kaiser Health News, the EHR stories have two sides – one bottom-up, the other top-down.

By Eric Whitney, Colorado Public Radio, January 22, 2013

The good news: Colorado is working to help kids stay current with their immunizations and has a computerized registrywhere any provider who gives a child a vaccine can report that information.

The bad news: The state’s computer system is not compatible with most of the computer systems doctors use, so many practices don’t update the central database because it’s just too much extra work, according to Dr. Allison Kempe, a researcher at the University of Colorado. That means doctors and researchers, who try to keep childhood immunizations on track, can’t rely on the database to make sure a vaccine isn’t missed or given twice.

This is just one small example of the digital disconnect that’s holding health care back, says Dr. Art Kellermann, a policy analyst with the RAND Corporation. He says the ability for doctors to easily share information is the exception in America, not the rule.

Kellermann co-authored an article in this month’s Health Affairs, reflecting on a study from 2005 that said information technology could save America $81 billion a year by making health care more efficient. He found actual savings scant in 2012 and learned that many doctors complain electronic records make them less efficient.

The result is that the health care industry isn’t benefiting from the computer networks that have transformed industries such as manufacturing, retail and banking.

Kellerman points out that bank customers can “go to any ATM in the country -- and in many cases in other countries” to withdraw money or transfer funds among accounts. “You can’t do that with health information technology today,” he says.

Dr. Farzad Mostashari, the National Coordinator for Health Information Technology, rejects the comparison. “People talk about the ATM,” he says, but “that’s seven data elements, and they charge you two-buck-fifty for shipping those seven data fields over. We’re talking thousands of data fields around things that are life and death.”

Mostashari’s office is charged with leading American medicine’s digital transformation, and it is responsible for distributing $27 billion in federal stimulus funds to providers who demonstrate they are meaningfully using health IT systems. According to a CDC survey, while 72 percent of office-based physicians are using some sort of electronic system in their practice, only 40 percent of practices meet the definition of a“basic” system

Mostashari’s office meets constantly with software vendors –- on average, one meeting every three and a half hours for the past three years, he says. They’re trying to hammer out the basic industry standards necessary to make sharing health information as easy as bank records or other important information.

Mostashari says the number of doctors and hospitals using electronic records has doubled in the last two years. Despite the growing pains, he says the government’s strategy is helping, though it will be another six years before the government’s IT strategy starts showing significant savings.

Both he and Kellermann agree that patients would get better care, at lower cost, if health care systems could share patient records easily. But that won’t happen until doctors and hospitals start getting paid for being IT-smart. Right now, duplicative testing also means duplicate payments. Kellerman is optimistic the Affordable Care Act’s payment reforms can change that.

“As we shift American health care and start paying for the best quality care and the best outcomes, rather than who does the most stuff, who orders the most tests or who does the most operations, then I think you’ll see IT becoming a tool for efficiency and high performance,” Kellermann says.

This story is part of a reporting partnership that includes NPR, Colorado Public Radio and Kaiser Health News.

I close with a limerick.

Data mongers say against EHRs I’m biased,

That my regard for data is not the highest.

My bias is towards clear communication,

For efficient transfer of useful information,

That doesn’t make me towards EHRs impious.

Tweet: Fastad Matahari, MD, National Coordintor For HIT, says it will take 6 years for EHRs HIT strategy to save the government money.