Electronic health records (EHRs) have become adopted for widespread use by a growing majority of U. S. physicians. It has been assumed that the wider adoption of EHRs would improve efficiency and patient safety, reduce diagnostic testing and medical errors, improve continuity and quality of care, and save money. Their use was accelerated by the Affordable Care Act (ACA) after its passage in 2010. The Centers for Medicare & Medicaid Services (CMS) have further stimulated their adoption by developing “meaningful use” criteria tied to reimbursement levels.
To be fair, EHRs have brought some useful capabilities to U. S. physicians, including electronic prescribing of medications, receiving clinical test results, electronic lab orders, electronic administration tools, and communication with patients. They have been helpful in home monitoring of high-risk patients, especially those with congestive heart failure, in reducing hospital re-admisssions. A 2015 survey of 600 U. S. physicians found that one in four physicians offered telemonitoring devices to patients to enable them to monitor their health care. That same study, however, found that less than one-half of surveyed physicians believed that EHRs improved patient outcomes.
Although EHRs have largely replaced paper records and brought some efficiencies to the process of delivering health care, there are some important problems that call into question some of the assumptions made by their architects. These are some of the unintended consequences of the widespread adoption of EHRs as they now are:
Based on the above, we need to conclude that EHRs have brought some efficiencies to U. S. health care but at a high cost, including high administrative costs and time, as well as adverse impacts on the doctor-patient relationship without evidence to date of improved patient outcomes. They have also become a billing tool that is vulnerable to gaming the reimbursement system by physicians and hospitals, contributing to the ACA’s inability to contain health care costs.
Despite grudging acceptance of EHRs by most physicians, they are here to stay. Nobody wants to return to paper records. The above adverse results are symptomatic of our profit-driven multi-payer financing system that reimburses physicians, hospitals, and other health care professionals and facilities within a hugely bureaucratic, fragmented and unaccountable health care system. EHRs have become a billing instrument for a system out of control. For separate reasons that add further complexity, believe it or not, we now have 140,000 different billing codes (not a typo!)
All of the above outcomes will continue unchecked until we fundamentally change the financing system by adopting single-payer Medicare for All and simplified administration, including standardized EHRs that are interoperable and based on evidence-based services. Improvement of EHRs will probably require this level of financing reform before they can include the kind of readily accessible information about evidence-based services as well as sufficient personal information about patient preferences.
EHRs should become useful from physician to physician and among health care facilities anywhere in the country. Their content needs to be re-thought so that repetitive templates of unnecessary clinical information are eliminated. Quality measures should be improved so as to be better aligned with outcomes of care. (GAO, Report to Congressional Committees, October, 2016.) Billing codes need to be reduced to rational and meaningful levels. Such useful medical and billing records have been achieved by many other advanced countries around the world with one or another form of universal access based more on a service ethic than a competitive profit-maximizing business “ethic.” They should be achievable if we have the political will, and should be the goals of our society on a non-partisan basis for the common good.
Source: John Geyman, Electronic Health Records: Panacea vs. Unintended Consequences, The Blog, HuffPost, October 26, 2017.
Adoption of certified EHR systems was seen as a potential antidote. By digitizing patient records and adding billing workflows around them, the efficiencies would drive down processing costs, it was theorized.
Perhaps the most frustrating issue with electronic medical records right now is that they don't talk to each other; hospital A and hospital B typically have different records, made by different vendors, that can't share information. This means that even if hospital A and hospital B are across the street from each other, you still need to phone in or fax or print out any type of medical information you wish to share.
In this era of instant data flow, many service industries have adopted technologies that allow for seamless information exchange. However, such has not been the case for the healthcare sector.
While cyberattacks on the health care industry may pose immediate health risks to patients, with consequences like hospitals closing and procedures needing to be rescheduled, the big concern must include data breaches, Cabrera said.
I believe that there are both good and bad aspects of EMRs, as they have the potential to both improve and worsen patient care. They are likely a step forward but also a work in progress, as there are perils lurking. The key for the health care profession is to continue moving forward by recognizing the vulnerabilities and remedying them, rather than ignoring them.
Despite this damning report, the majority of physicians these days are dealing with one or more EMR systems to document their clinical activities these days. If you deal with more than one ... for instance one in the office and another in the Hospital ... the odds are they don't communicate with each other.
But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.
Speak up. Make some noise. Get doctors off the white screen and back to the business of doctoring. Now that would be meaningful.
Apple's Health Record app allows patients to pull in their healthcare info from multiple providers onto a single record they can share with clinicians, regardless of where they work. Here's how that's working for two hospitals.
Although research into their impact on quality of care and patient safety remains modest and is often controversial, these tools have eliminated considerable issues related to poor physician handwriting and have greatly improved internal and external provider communications and reporting.
So, in spite of the wonderful face of electronic information, there is a glaring gap causing me to regress to the 1980s. I need to fax, spend hours on auto-attendant hold and write out paper forms. Haven't I spent thousands of dollars to create an efficient electronic office? Apparently not.
Storing and retrieving your health and medical information couldn't be easier. And you can carry it with you anywhere you go. Here's our picks for the EHR that may work for you!
"Digital records are also being aggressively used to maximize patient billings," and other imperfections on the route to a more sensible health care system.
So, if EMRs facilitate the delivery of health care why is it taking so long for the medical community to embrace EMRs?
The future of EMRs is uncertain, but one thing remains clear: we ultimately still want to pursue the “one patient, one record” ideal and in order to achieve that we might need to head back to the drawing board.
Perhaps someday implantable chips will be so pervasive that a quick body scan will provide instantaneous medical information. Do we really want it?
HOW far would you go to protect your health records? Your privacy matters, of course, but consider this: Mass data can inform medicine like nothing else and save countless lives, including, perhaps, your own.
Without doubt, electronic medical records are killing and injuring people, for some of the same reasons that airplanes crash.
"Yes, there are problems in any technology implementation and there always will be. But fewer people die. Yes, it is important to connect with the patient. But fewer people die. Yes, the opportunity to pad billing is obscene. But fewer people die."
The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.
Big data could provide early warning of disease—if medical records can learn to talk to one other.
Sadly, the systems are very, very bad indeed. It is said that use of an EMR, versus paper charts or dictation, typically reduces physician productivity by about 30% right out of the box. It is also noted that now, young physicians in training spend more and more time at keyboards and less and less time looking at that pesky throwback to ancient times, the human patient. (How dare they not be pixelated!)
Although EHRs have largely replaced paper records and brought some efficiencies to the process of delivering health care, there are some important problems that call into question some of the assumptions made by their architects.
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