Since the meaningful use criteria came out, many providers of healthcare have been crying out, "Not so fast!"
Electronic health records (EHRs) came on the scene in the 1970s. Yes, the 1970s. The family medicine department at the Medical University of South Carolina and other daring practices implemented them. The computer age had begun.
In the 1980s, networking with personal computers won the battle over the big machines, and more EHR options became available. Microsoft's dominance in business was in full swing, and MS-DOS was a great operating system for EHRs. More innovative practices came on board.
In 2004, Department of Health and Human Services (HHS) Secretary Michael Leavitt and the first HIT "czar," David Brailer, MD, PhD, declared the 2000s the decade of HIT. They stated a goal of universal penetration of EHRs by 2014. In 2009, President Obama reiterated this goal for 2014 and provided $19 billion in funding via the Health Information Technology for Economic and Clinical Health Act as part of American Recovery and Reinvestment Act of 2009.
More than 10 years ago, the Institute of Medicine released its groundbreaking report "To Err is Human" and called for the end of physician and nurse handwriting within five years to reduce errors and save lives. Politicians across the political spectrum, from the liberal Patrick Kennedy to the conservative Newt Gingrich, declared that "paper kills" and have called for universal adoption of EHRs.
Now, in 2010, a large number of private practices have yet to implement EHRs, and the government is getting tough. After all, most of the modern world is way ahead of us. In Europe and New Zealand, more than 90 percent of physician practices have had EHRs for years. If there were an Olympics for the use of HIT, the United States would be far down the list of medal winners.
The meaningful use criteria were written by physicians for physicians. David Blumenthal, MD, MPP, the federal government's second and current HIT czar (his HHS title is national coordinator for HIT), and Paul Tang, MD, MS, chairman of the federal HIT Policy Committee's Meaningful Use Work Group, which advises HHS, are both experienced primary care physicians. They know how certain applications of HIT will avoid medical errors and save lives. It is time for all of medicine in America to follow their lead.
Significant medication errors happen in seven percent of all hospitalizations, and such errors are even more common in office practice. A leader in the retail pharmacy industry told me that more than 30 percent of all handwritten prescriptions need some correction at the pharmacy. The pharmacies cannot catch all the mistakes. Successful lawsuits have been brought against physicians because of harm caused by poor handwriting.
It is impossible for humans-and physicians are human-to remember all significant drug interactions. More than 50 commonly used drugs cause prolongation of the QT interval of the heart and if used together in an at-risk patient may cause sudden death. The list of drug interactions with warfarin in both directions of anti-coagulation effect is too long for anyone to remember.
Rocket scientists need computer support to do their jobs correctly, and we physicians do, too. It is time for us to give up "medicine by the seat of our pants" and work with HIT to provide safe and consistently effective care. The standard of care now requires that, and you know what that means in legal terms.
EHRs and other HIT applications are expensive, and the quality of the software has been a problem, but the time for excuses is over. We do not tolerate a lack of safety in industries such as air travel and automobile manufacturing. The number of people dying in the United States from medical errors could fill two jumbo jets every day. The meaningful use of EHRs and other HIT such as clinical decision support software will go a long way in making medicine safer.
Members of the public and their elected representatives are lowering the boom on us, and it is time for us to respond en masse. Welcome meaningful use of HIT and get a certified EHR system application for use in your office.
The author, a Medical Economics Editorial Board member, is a family physician and vice president for primary care at Eisenhower Medical Center in Rancho Mirage, California. He also is a clinical professor of family and preventive medicine at the University of California, San Diego. Send your feedback to firstname.lastname@example.org