Monday, August 9, 2010

EHRs – A Voice in the Wirelessness: Documenting Distracts from Doctoring

I do not think the government strategy of spreading EHRs to every nook and cranny of the health system – to every hospital deparment, to every primary care and specialist office, to every government and private payer – will succeed or is even desirable.

Yet, I know these wondrous EHR systems will supposedly cut errors, improve care, reduce waste, appeal to patients, ease communication and ensure transparency between all health care parties, make it possible to track doctor performance, and aid government in forcing doctors to comply to federal standards.

But I also know hospitals and doctors are not yet persuaded EHRs are the right thing to do. As David Blumenthal, MD, Obama’s HIT czar, comments in the August 9 NEJM,”We have not moved significantly to extend the availability of EHRs from a few large institutions to the smaller clinics and practices where most Americans receive their care.”

This failure to persuade doctors has not deterred government experts. Government has upped the ante by making available $27 billion over the next ten years, as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per doctors.

These financial incentives are designed to serve as a "lift-off” for a nationwide system of EHRs, provided clinicians adhere to 25 “meaningful objectives” that will measure their care and compliance to federal regulations.

In today’s August 9 WSJ, the reporter says major health plans have joined the hunt for EHR monies. The plans will help doctors install EHRs in the hope that clinicians will qualify for federal subsidies.

In response to the WSJ blog, I wrote.

“It amazes me how unreal and surreal people are about electronic health records (EHRs). The government and the IT crowd has been going ga-ga about EMRs for eight years now. Yet the NEJM reported recently that only 1.5% of hospitals and 6.0% of doctors have ‘fully functioning’ EHRs. Others claim 10% of hospitals and 20% of doctors have partial EHRs.

What’s the problem here? Simply this. EHRs aren’t terribly useful clinically, distract from patient care, don’t talk to one another, drop productivity and income by about 30%,and fail to help doctors communicate with each other, hospitals, and patients.

I suppose $27 billion in federal bribes and stimulus money may solve these problems as more and more players - EHR companies, policy works, IT experts, consultants, integrated health systems, and health plans - gather at the federal trough.”

I may be a voice in the wirelessness, but it strikes me that the zeal for documentation through data does not assure and may even distract from good doctoring and time spent with patients. The massive government push to install EHRs, may have a backlash: doctors not accepting Medicare and Medicaid patients to do what they think, not the government, is best for patients.

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