Viewpoint: EHR change we can believe in?

February 5, 2009

The early days of the Obama administration give the estimated 83 percent of doctors without an electronic health record system valid reason to sit tight for a while longer.

For a moment, it doesn't really matter whether you're a Democrat or Republican or neither of the above: These early days of Barack Obama's presidency offer us all a sliver of optimism that a new administration might right the course of health care in America.

And now for the bonus round: These days also give the estimated 83 percent of you without an electronic health record system valid reason to sit tight for a while longer.

Obama has said that government cash will flow freely-he has called for $50 billion over the next five years-to ensure that all of America has EHRs by 2014. Consider it a reinforcement of the 10-year goal for EHRs set forth by George W. Bush five years ago.

We have learned since Bush's decree that it's awfully hard to implement sweeping infrastructure changes in five tidy years, especially when collapsing markets and international conflicts constantly vie for attention.

We're now halfway to the 2014 goal, and we have yet to contend with such details as how a universally acceptable system will be devised and implemented, how it will be funded, how HIPAA will be re-envisioned to accommodate it, and where we'll find the brilliant IT workforce to make it all happen.

Legislators, you're on the clock. And physicians, for once, you're not. Enjoy it while you can.

You should still believe that constant voice in your ear that's whispering EHR is inevitable, but you can breathe easier until you hear other voices detailing exactly which EHR is the right one for you, or how you will be able to afford it, or any of a thousand other reasonable questions that remain to be answered. Even EHR vendors must sit idly by, awaiting word on what is required of them to lead us all into the next generation of health care.

EHR advocates are loaded down with questions too. To Stephen R. Levinson, MD, author of the book Practical EHR: Electronic Record Solutions for Compliance and Quality Care, it's not the EHR mandate that's the problem-it's the inherent flaws in the system currently accepted as the national standard.

In 2005, the Department of Health and Human Services contracted with the Certification Commission for Healthcare Information Technology (CCHIT) to develop a plan for universal EHR certification. Though not an arm of the federal government, CCHIT has become the government's official certifier of EHRs. For this reason, CCHIT has also become synonymous with exasperated gasps from physicians unable or unwilling to invest in the technology.

But Levinson, a retired physician of 26 years, points out that even CCHIT-certified EHRs are causing compliance problems in documentation and coding for the practices that use them. Those problems, Levinson believes, are the result of certification criteria that broaden the potential value of EHRs but also multiply the risk of noncompliance, whether intentional or inadvertent.

He calls this the "perfect storm of failed implementation." For a country that is 5 years into its 10-year plan, this is not a good sign.

Levinson has laid out his concerns before CCHIT and encouraged other groups, including the American Medical Association and the American College of Physicians, to do the same. CCHIT, for its part, invited all "stakeholders" (i.e., you) to chime in as well, during a period of several weeks in December and January.

But Levinson, like most of us, admits that he does not sufficiently understand the machinations of bureaucracy and politics that have brought us to this mess.

"I am a scientist," he explains, and scientists find solutions first by identifying the problem, then by sorting out the causes of that problem. And this is not what's happening right now.

Just like CCHIT and just like Obama, we don't yet have all of the answers. But we'll share the best information that we can as the pending EHR change becomes clearer. Here's hoping it's change we can all believe in.