Public health advocates have long lamented the uncoordinated nature of patient care. For example, your doctor may order an MRI scan and then refer you to a specialist, who wants his own MRI scan. Doctors in unrelated fields rarely talk to each other about their patients in common because nobody pays them to coordinate care. One common problem occurs when patients are on multiple medications prescribed by two or three different doctors, none of whom know all the drugs their patients are on. Coordinating care among physicians is difficult: requiring one busy doctor to play phone tag to get another busy doctor on the phone.
Some of the benefits of electronic medical records were supposed to be better care, more efficient care and better care coordination. It didn’t happen that way. In a (now) 5-year old analysis Kaiser Family Foundation discussed what went wrong: The article, Death By 1,000 Clicks: Where Electronic Health Records Went Wrong outlines an all too familiar tale.
Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country — essential when life-and-death decisions are being made in the ER.
In the decade prior to the article, the percentage of U.S. hospitals with electronic medical records rose by more than 90 percent. Still the software failed to live up to expectations:
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.
Especially in the early years I heard patients complain about exams with physicians’ face buried in a laptop desperately searching for pull-down menus with which to enter information. Systems often had menus for information that public health researchers wanted collected that doctors did not care about. One article from years ago discussed why there were so many Albanian patients at a certain medical center. There weren’t. The first choice of ethnicity on the EMR was Albanian. Doctors could not skip it.
Kaiser Health News goes on to say that despite all the hype about improving patient care, the systems were originally optimized for billing – making it easier to inflate charges by upcoding medical services. Other problems include serious software glitches that threaten patient care, causing thousands of deaths and serious injuries, mostly hidden from view. Numerous software EMR vendors require gag clauses where hospitals, clinics and doctors cannot speak out about problems. Even proponents admit EMRs have not worked as promised.
David Blumenthal, who, as Obama’s national coordinator for health information technology, was one of the architects of the EHR initiative, acknowledged to KHN and Fortune that electronic health records “have not fulfilled their potential. I think few would argue they have.”
The Kaiser Health News analysis was originally published five years old. Sadly, little has changed in the past five years. The government’s investment was $37 billion back in 2019. Yet, Google turns up numerous recent articles on the failure of EMRs. One recent example is the VA Health System.
Why have EMRs been such a failure? That’s actually easy to explain. It’s because hospitals are not competing on price, quality and other amenities. If hospitals are not competing on the basis of price and quality, they have little incentive to adopt EMRs that improve quality and reduce patients’ cost. That explains why EMR systems are optimized for billing. EMR software vendors are competing for hospitals’ business. Thus, they look for ways to appeal to hospitals. Inoperability with competing hospitals systems is not an advantage so record systems often do not talk to each other, while billing and upcoding are advantages. Health policy analysts predicted a decade ago and even earlier that hospitals had little incentive to adopt systems that were not in their self-interest.
The article, Death By 1,000 Clicks: Where Electronic Health Records Went Wrong is definitely worth reading.