Tuesday, April 14, 2015

Electronic Health Records - Document Friendly But Not Doctor Friendly

You can say a lot of things about electronic health records(EHRs).

They are great at collecting and documenting data. They are the hope and dream of “data-driven” and of “evidence-based” documentarians . Congress has voted to spend $30 billion to promote their usage. They cost a passel of money - $28 billion so far in government incentives to doctors and hospitals to install them. There are a lot of them out there : they adorn 80% of physician offices and 60% of hospitals. They are the coming thing at the dawn of computer medical age. They are likely to be the basis for comparative research efforts to judge what procedures and what treatments to pay for and what groups of doctors and what hospitals to put in into what networks of caregivers to favor with government or insurer contracts. They replace vague subjectivity with specific objectivity.

And, at the same time, EHRs don’t work very well for doctors who say they interfere with personal patient interaction. Doctors claim you can’t simultaneously look for buttons to press and read patient’s face and decipher their body language and interpret what words patients use. In a 2014 Physicians Foundation survey of 20,000 physicians, 85% of doctors said they had EHRs, but 24% said EHRs detracted from quality, 46% from efficiency, and 47% from patient interaction.

And here’s the kicker, according to an Obama administration report, “Spurred by $28 billion in incentives to date, nearly 80% of doctors and 60% of hospitals have converted from paper files to electronic health records, known as EHRs since 2009. But only 20% to 30% of providers are able to share records with outside providers, according to government and industry surveys.” (“ Obama Administration Report Slams Digital Health Records:Report Criticizes Vendors for Making It Costly to Share Patient Information,”Wall Street Journal, April 10, 2015)." In other words, to use 8 syllable word, EHRs are 70% to 80% "uninteroperable," meaning they don't talk to one another, communicate, or share data, and to make matters worse, they don't transmit an understandable narrative, i.e. tell the patient's story in plain English.

All of this makes you wonder, What good are electronic health records, if they decrease quality, efficiency, and patient interaction? You can argue, of course, as the Obama administration has : that any general government program of enormous scale has inevitable glitches, that these glitches and inefficiencies, are the inevitable result of an ambitious governmental agenda, that it is somebody else’s fault - troglodyte doctors or greed-stricken EHR vendors; that transformation and reform of the giant health care industry takes time and patience; that what is needed is more government standardization and regulation.

Or, I suppose, you could argue, after 10 years of this push for a nationalinteroperative EHR program, maybe we ought to rethink this EHR thing. Maybe after the litany of complaints from doctors, there’s something fundamentally wrong with our approach. Maybe we ought to ask the doctors what kind of system would fit their needs and those of their patients Or maybe it just takes time to shake out.

No comments: