Electronic health records (EHRs) are among doctors' major frustrations, yet their objections are rarely heard where they can make a difference. At the Health Information Technology Advisory Committee meetings, which take place a few times a year in Washington, independent doctors are conspicuously absent. While several hospital-employed doctors sit on this high-octane panel, they and most of the other HITAC members primarily represent corporate healthcare: hospital systems, large insurers and big IT companies (Sutter Health, Anthem Blue Cross, Accenture, Epic, to name a few.)
A Washington-based organization, HITAC makes recommendations to the National Coordinator for Health Information Technology about what health IT should be implemented, how and when. In short, it directs the future of EHRs.
What strikes me, however, is that the very committee largely responsible for shaping how independent doctors spend their time is missing that group’s voice at the table. While independent doctors are removing gallbladders, reading x-rays, and working on their electronic medical records, those working in corporate healthcare sit on the penthouse level of a Marriott determining how many more hours a day doctors will have to spend entering data into electronic health records if they want to be paid.
Now, independent doctors may be missing from the discussion simply because they’re too busy, or their absence may be by design. Regardless, that needs to change.
In September, I attended the HITAC meeting, and spoke during the public comment period on behalf of independent doctors, whom I hear from every day.
I hear from doctors like this pediatrician who recently lamented, “Electronic health records was pitched to doctors as the panacea, the way to integrate and share health information across systems for the benefit of patients and doctors. No longer were doctors going to have to search for paper charts or transfer information between offices and hospitals and clinics, or run duplicate tests. Electronic health records would be easily accessible.” Except, that didn’t happen. Instead, EHRs “became the bane of our livelihoods: time-consuming, exorbitantly expensive, and without interoperability. They don’t enhance, but rather degrade patient interactions, serving only as a data source to help insurance companies with their coding and billing.”
And I hear from doctors like this cardiologist who called my office at 5:30 pm, a time when many workers are winding up their days, but not him. Although he was done seeing patients, he said in a voice of resignation, “I’m surrounded by 45 dictations I need to do to please the bureaucrats before I go home, eat, see my family, sleep and do it all over again tomorrow.”
On their behalf, I made a five-minute comment to the committee, which you may listen to here, and in essence said the following:
While Health IT will continue to play a formative role in healthcare, and while it has the ability to improve the sharing of patient information, I, speaking on behalf of the more than 1,000 independent doctors who have joined the Association of Independent Doctors, have some concerns:
I'm concerned about the additional burden EHR places on doctors who already spend seven of 10 hours a day entering patient data, and who feel like the country’s most expensive data entry clerks.I'm concerned about how EHR requirements will continue to drive doctors out of private practice and into hospital employment, because doctors are uncertain about which EHR systems to choose, and worry that their investment won’t mesh with the ones the health systems in their area use.I'm concerned that as EHR drives consolidation it will contribute to higher health-care costs, and further erode the patient-doctor relationship by stealing more of doctors’ valued time.I'm concerned that, if not done carefully, IT will, in its move toward control and compliance, continue to benefit health systems, insurers, and IT companies, at the expense of patients and doctors.I'm concerned that hospital systems, in their desire to own market share by employing physicians, will use EHR not as a tool but as a weapon, to exclude independent doctors. Independent physicians often have trouble accessing electronic health records from other providers and systems, an obstacle some believe is by design.I’m concerned that Health IT is building walls, not bridges. When I read terms like "closed-loop communication" and "referral management" in the HITAC task-force committee report, these sound like euphemisms for steerage and leakage, words hospitals use when ensuring their employed doctors only refer back into the parent health system.I'm concerned about the lack of nuance inherent in health IT. Before we agree on "levels of granularity," we should focus on what we might lose in the collection process. Not all medical situations fit into a neatly checked box.
All that said, and putting those concerns aside, IT should absolutely play a positive, patient-centered role in healthcare. Done well, IT has the ability to not only benefit America's patients and doctors, but also to drive down health-care costs by delivering access to real price transparency and outcome data. Access to real price transparency is the door to a competitive, free market in healthcare, and IT is the key.
If there were ever a moment for technology to change the course of our country's over-priced health-care system, this is it. But it won’t happen so long as self-serving interests are in charge.
Those who want to protect the status quo will say health pricing is too complicated to be made easily available and transparent. I say, nonsense. Alexa, Uber, Zillow, Expedia and Amazon all take gigantic data sets and provide real-time information to consumers all the time. Healthcare can, too.
Currently, the committee has two open seats. I have been nominated for one. It’s a longshot, and, frankly, whether I get appointed or not isn’t what matters. What does matter is that someone who represents independent doctors and their patients does get a seat at that table.
Marni Jameson Carey is the executive director of the Association of Independent Doctors, a national nonprofit trade association that works to support doctors who want to remain independent. You may reach her at firstname.lastname@example.org. To become an AID member, go to www.aid-us.org/join.