Is the EHR an ill-conceived obsession?

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

 

For drugs or medical devices to be approved, there must be evidence that benefit significantly outweighs risk. This is to protect the public. 

A glaring exception is today’s EHRs, which were mandated by the 2009 HITECH Act.  Though never field tested and proven beneficial, these “certified” systems must be used for full reimbursement from Medicare/Medicaid. This is unlike other areas not as complex as healthcare, such as banking, which developed its electronic systems over many decades. The thrust for this imprudent rush was in part a study by the Rand Corporation, later retracted as incorrect, which promised billions in savings that have NOT materialized. 

An internet search looking for the benefits of EHRs reveals many government sites touting their benefits, but NO scientific studies to support these claims.  Some of the benefits the government expresses:

Assertion

1) Enabling quick access to patient records for more efficient care

Reality: Present EHRs have reams of superfluous information, copy/pasted out-of-date histories and physicals so as to require MORE time to assess the patient.

2) Securely sharing electronic information 

The “certified” EHRs from various companies do NOT share information. Also they are NOT secure, with huge numbers of data breaches.  This lack of security limits the truthfulness of patients revealing sensitive information to their physicians thereby limiting discussions for improved behavior.

3) Helping providers improve care

It is documented that physicians are spending most of their time meeting the requirements of the present EHRs and other administrative busy work. Our EHRs limit physician time with patients, increasing the chances of errors, disrupting the patient-doctor relationship and contributing to physician burnout.

4) Improving patient-provider interaction

The present EHRs and other administrative tasks are destroying the patient-physician relationship. 

5) Enabling safer prescribing

 This was available long before the HIGHTECH Act.

6) Promotes legible documentation and better billing

Documentation is legible but overwhelming; the emphasis is NOT patient care, but rather a billing document.

7) Enhances privacy & security

Systems are being compromised every day. Data breaches, as of 2015, number over 94 million records at a cost $50.6 billion (http://bit.ly/1UAaOhu).

8) Helping providers improve productivity

Studies have shown that productivity is markedly DECREASED; the extra burdens of documentation are oppressive.

9) Enabling providers’ business goals

Efficiency is severely diminished and costs are exorbitant, greatly impeding business goals.

10) Reduces cost

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