Friday, March 27, 2015

Physician Response to Electronic Health Records a Mixed Bag

Although the federal push for electronic health records (EHRs) is now 10 years old and although 70% to 80% of practicing physicians now have these records, physicians are of mixed mind about the effectiveness of EHRs.

This mixed reaction is best shown in a 2014 Physicians Foundation survey of 20,000 physicians. When asked how they felt about EHRs, physicians gave these responses: increased quality of care, 37.3%; decreased quality of care, 27.4%; increased efficiency, 24.3%; decreased efficiency, 45.7%; enhanced patient interaction, 4.6%; distracted from patient interaction, 47.8%.

Clearly, in many respects, EHRs have not achieved their goals of improved quality, greater efficiency, and enhanced physician-patient interaction.

In an Op-Ed piece in the New York Times ( “Why Health Care Tech Is Still So Bad,” Robert M. Wachter, MD, a professor of Medicine at the University of California in San Francisco, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, contemplates why EHRs have such a mixed record.

“Last year I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state of the art operating rooms, dazzling radiology equipment, a a lovely suburban location. But only one line was printed in red.: “No EHR.”

“The unanticipated consequences of health information technology are of particular interest today. In the past five years about $30 billion of federal incentive payments have succeeding in rapidly raising the adoption rate of electronic health records. The computerization of health care has been like a car whose spinning wheels have finally gained traction. We are so accustomed to standing still that we were totally unprepared for that first lurch forward.”

Doctor Wachter , a pro-health information advocate, took a year’s sabbatical to write his book , In the course of that year, he interviewed, among others, Erik Brynjolfsson, a management professor at M.I.T,, Boeing’s top cockpit designers, Silicon Valley iPhone entrepreneurs, I.B.M’s Watson team, and, of course, his digital doctor brethren.

In his book and his Op-Ed piece, Dr. Wachter argues “Health, our most information-intensive industry, is plagued by demonstrably spotty quality, millions of errors and backbreaking costs.” He concludes, “Electronic records will transform medicine, eventually.” To achieve this utopian goal, he says physicians will have to focus on patients rather than demands of the computer, work together in teams, and government will have to mandate the seamless shoring of data between different systems in different settings.

In a related Wall Street Journal article (“Why Health-Care IT Systems Must Be Made to Talk to One Another" March 27, 2015), Wachter observes, “The proportion of doctors’ offices with electronic records has skyrocketed. Our health system finally has a digital backbone. But the backbone’s vertebra are mostly unconnected. What we are lacking is called interoperability.” Once that is achieved, presumably we will have a seamless, vastly improved health care system.

I am not so sanguine. I believe medicine, an intensely humanistic, interactive endeavor, will still require clinical judgment and gut reactions. Long live the gut. Keep the data, churned out day and night by computers and iphones and apps, in perspective. In the words of Dr. Wachter, computers are “Just an essential tool. Nothing more, nothing less.” They are not the end game of medicine, just one way of getting there.

No comments: