The government's Meaningful Use program mandating electronic health records is out of touch with reality. EHRs bog down process and can even worsen care.
Despite the existence of a government program called Meaningful Use, as a doctor I have yet to see a meaningful, positive impact on care from electronic health record (EHR) systems.
Regulators pushing for better and more cost effective medicine have decided that electronic technology, which has revolutionized many industries, is the solution needed to revolutionize medicine. We have been told that EHRs will make us better doctors, and they will make patients more responsible and engaged in their care. They go so far as to claim that EHRs will save doctors and hospitals time, that they will provide better coordination of care and save lives. While I can envision a world where this could be true, those of us living in the real world struggle with the disconnect between what is touted and what we experience every day.
It is true that some studies have shown specific benefits on selected measures when EHRs are used. Unfortunately, this is not true in all studies. Some studies have failed to show improvement of any kind when an EHR system is implemented. Some show an increase in adverse outcomes, including death. The EHR is not a proven technology. It is an experiment, and hospitals and clinics are beta testing new ways of doing things every day. The en masse adoption of EHRs into hospitals is akin to forcing car makers to make all vehicles from a new plastic that theoretically could make them safer without having shown that it really works.
High expectations for a new technology are typical, but pushing adoption of a technology that hasn't proven itself yet is inappropriate and flawed. Many haven't seen improvement in care coordination, efficiency, or patient engagement. In fact, some think things are worse with EHR. Patients now have to compete with computers to get their provider's full attention. Good documentation can take more time to input, and coordination of care still requires highly motivated teams. It is not clear if the EHR is more effective that a cohesive team with a spreadsheet. Additionally, health information exchanges are years away from truly interconnecting institutions and are not adding proven benefit to many.
Part of the problem is the menagerie of disconnected proprietary systems, all trying to solve problems in their own way. They don't speak to each other. Many are plagued with poor design and poor usability. These problems can be solved, but they should have been solved before we bought the software, not after.
In an effort to push EHR adoption and use, the Center for Medicare and Medicaid Services (CMS) has created the Meaningful Use (MU) incentive program, which defines what people should be doing with their EHR and pays them for doing it. The CMS has also instituted penalties for those who would remain on the sidelines. MU Stage 2 is ongoing, with the goals of increasing use of health information exchanges and patient engagement by enabling patients to access and transmit their own data. It also requires more intense use of EHR by physicians who must order tests, e-prescribe more consistently, look at labs in an electronic format, and keep everything safe from hackers.
On the surface, these seem laudable. Yet the technology remains cumbersome and disconnected, making many of these tasks difficult at best. Some tasks require someone else to act -- the patient or the health IT vendor. Even with a certified product, meeting MU Stage 2 requires overcoming some major hurdles. It is not clear that any of these things are improving care or saving time, money, and lives, as claimed by the CMS.
For example, in spite of compelling evidence to the contrary, computerized physician order entry (CPOE) is being pushed as the most efficient and safest way to order tests, order medications, and use standardized order sets. Certainly, when coupled with clinical decision support, there might be
David M. Denton is a board-certified pediatrician and member of the American Academy of Pediatrics. He is a partner of the Pocatello Children's Clinic in Pocatello, Idaho, and is affiliated with Portneuf Medical Center where he currently serves as the medical staff ... View Full Bio
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