There were a couple of stories about electronic health records last week that are causing a stir in the U.S. medical community. The first was an op-ed published in MIT's Technology Review titled, "Why Doctors Don't Like Electronic Health Records" and written by Richard Reece, a retired pathologist.
Dr. Reece says that despite the billions in incentives to adopt electronic health records, many doctors in the United States are still resisting implementing EHR systems—particularly in small practices. Part of the problem, he says, is that EHR systems get in the way of doctors trying to understand their patients' medical conditions. Dr. Reese writes:
"The computer is oversold as a tool to improve health care, implement reform, cut costs, and empower patients. The reasons are obvious to anyone who treats patients. You cannot look a computer in the eye. You cannot read its body language. You cannot talk to an algorithm. You cannot sympathize or empathize with it.
"We physicians are not Luddites or troglodytes. We are savvy about using the Internet, technology applications, and social media. For us, medicine mixes art and science. What we seek from patients are clues, constellations of signs and symptoms, and stories. We choose not to be reduced to data entry clerks sorting through undigested computer bytes."
The issue of trying to manage both the patient and the EHR simultaneously has been an issue for quite some time. As Lisa Gualtieri notes in this post, far too often doctors lose eye contact—and emotional contact—with their patients as they focus on entering information into an EHR. Another recent blog post in the New York Times underscores this concern.
One recommendation is to use scribes—often, pre-med students—to input the information into the EHR during a patient consultation. This has worked well for some hospitals, but it may not be a practical or affordable option for smaller medical offices, which make up over half the medical practices in the United States.
Dr. Reece also voices concerns about EHR designs that often seem to frustrate a doctor's quest to understand a patient's condition rather than inform it.
In addition, Dr. Reece points out that the short-term as well as long-term costs—especially needed to meet the ever increasing governmental financial incentive criteria—too often outweigh the benefits of implementing EHR systems. As a result, Dr. Reece writes,
"Many doctors are seeking refuge from bureaucratic demands by retiring, closing practices to new Medicare and Medicaid patients, or seeking hospital employment."
Other doctors have voiced similar opinions, especially as states such as Massachusetts begin to mandate doctors use EHRs if they want to maintain their medical licenses.
Another issue Dr. Reece raised is that physician practices, and I suspect hospitals too, are struggling with trying to determine which EHR system is the best fit. As this Bloomberg News article from about two weeks ago points out, some 750 companies are now in the electronics health record and associated technology market as a result of the $27.4 billion the U.S. government has set aside as incentive money. This is double the number from just two years ago. Not all of them are going to remain viable concerns; so choosing an EHR wisely is critical if a physician practice doesn't want to endure the high (non-incentivized) cost of switching to a new EHR system in the future.
As Dr. Reece pointed out in his op-ed piece, doctors don't like the feeling that they are becoming data monkeys. They will probably feel that way even more given the news of a study appearing last week in Health Care Management Review that indicated that an unintended consequence of EHRs may be the reduction of doctors' clinical decision-making skills. Although the study involved only 78 primary care physicians, the findings shouldn't be all that much of a surprise. The FAA is struggling with the same issue with flight management system automation and the degradation of airline pilot skills.
Even with all these negatives, however, Dr. David Blumenthal, the former National Coordinator for Health Information Technology and now a Harvard Medical School professor of health care policy, argues forcefully that EHRs do make doctors better. In a Boston Globe article two weeks ago, Dr. Blumenthal wrote that the EHR learning curve may be painful, but it is a necessary one to go through if health care costs are to be contained and patient care is to be improved. A little patience is needed, he says, because EHR systems are improving all the time.
According to the Bloomberg article above, and this one at Modern Healthcare, as of August 31, some 90 650 medical organizations and individuals out of some 530 000 eligible have registered to participate in the EHR incentive program, with US $653 million paid out so far by the U.S. government. However, Bloomberg reports that only about 7000 have received "initial payments for demonstrating meaningful use of digital records."
To try to help speed up the adoption of EHRs, last week medical insurance company Blue Cross and Blue Shield of North Carolina announced a $23 million collaborative program with EHR system provider Allscripts to help with the purchase of the latter's EHR system for 750 doctors and 39 free clinics in North Carolina, an article in the Charlotte-Observer reports.
Blue Cross expects to recoup its $15 million investment by eliminating inefficient and ineffective medical practices and unnecessary bureaucratic overheads that some say account for nearly 20 percent of medical costs. Blue Cross, however, told the Charlotte-Observer, "...those savings wouldn't automatically translate to a 20 percent cut in premiums, but they would help the company manage spiraling health care costs."
I'll let you interpret that statement as you will.
Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.