An interesting article over at Kaiser Health News on electronic health records (EHRs):
But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment…Today, 96 percent of hospitals have adopted EHRs, up from just 9 percent in 2008. But on most other counts, the newly installed technology has fallen well short. Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them — which is more than the hours they spend with patients. Unlike, say, with the global network of ATMs, the proprietary EHR systems made by more than 700 vendors routinely don’t talk to one another, meaning that doctors still resort to transferring medical data via fax and CD-ROM. Patients, meanwhile, still struggle to access their own records — and, sometimes, just plain can’t.
The article claims that EHRs are often optimized for billing (i.e., to extract as much money from insurance companies as possible) rather than for patient care. Further, because of the lack of EHR interoperability, lab orders get lost, prescriptions mixed up and patient outcomes can be worse. Lawsuits have resulted.
While the article focuses on the downsides of EHR, clearly they have the potential to improve efficiencies and communication. How this can work in practice, however, is an area where more research is needed.
This is a reality that has played out like many in health care, with patient and physician input seeming at the bottom of the list. There is an unavoidable tension between privacy and interoperability. As well, the presumption that teams care for patients, while unequivocally a part of the process, has relegated the individual relationships, especially the patient-primary internist one, to a more subsidiary role. While I have overcome this with the concierge transition, it is a disservice to patients and primary care physicians that has been totally overshadowed by the rhetoric.
In a complex world of multiple options, ever-changing science, and little and big issues, having a longitudinal relationship and easy access is a crucial cog to optimizing the health-care process. We have not rewarded caregivers in this domain; indeed, we have handicapped them with bureaucratic tangles and inefficient technologies. I dare not ask my vendor for assistance, as they have to keep the big practices MIPS and MACRA ready.
It is disconcerting that all of these changes have left independent physicians less and less of a place in the mainstream of medicine. All the while, for-profit insurance, a dysfunctional brand-generic landscape, and large consolidated health care systems carry out their bureaucratically heavy and corporatized undertakings less efficiently than the old, decentralized way. Big data may have a role, but the one-on-one is still the cog in the wheel.