• Electronic Health Records have a long, long way to go

    I’m on record as being a pessimist on the adoption of EHRs across America. I’m just saying.


    Although doctors who are using electronic health records in a meaningful way are eligible for a $44,000 bonus from the U.S. government, many still haven’t adopted the new technology, a new study shows.

    Overall, just one in six doctors has adopted electronic health records significantly enough to qualify for the bonus, the study found.

    “These are the doctors that have attested to using the electronic health records. My guess is that more people are on the journey [to using electronic records] than have attested to it. But, there are still some physicians who haven’t started using electronic health records at all,” said the study’s lead author, Adam Wright, a senior research scientist at Brigham and Women’s Hospital and an assistant professor of medicine at Harvard Medical School in Boston.


    Less than 10% of specialists and 17.8% of primary care providers attested to enough meaningful use to receive incentive payments through Medicare and Medicaid as of May 2012, according to a letter published in the Feb. 21 issue of the New England Journal of Medicine.

    The letter itself:

    Although these data suggest rapid growth in the number of providers achieving meaningful use, this pace must accelerate for most eligible professionals to avoid penalties in 2015. Barriers to EHR adoption and meaningful use include cost, lack of knowledge, workflow challenges, and lack of interoperability. A total of 62 federally funded regional extension centers assist eligible professionals with EHR adoption. These centers have exceeded their enrollment targets, but only 15.9% of eligible professionals who have enrolled in regional extension centers have shown meaningful use, and long-term financial support for the regional extension centers is uncertain.

    My pessimism continues. Throwing money at the problem isn’t enough.


    • Yeah.

      I’ve been writing about this on my REC blog, where I routinely bite the hand that feeds me.

      We even have a hashtag now on Twitter, “EHRbacklash”


    • In my community, all the major hospital systems use EPIC. I find it a clutzy system. When I started in1979, it was common for heme/oncs to see 30 patients a day. The charts were handscribbled and very brief, but people got seen. In the days of dictated charts, I was seeing 20-25 patients per day. With the EHR, I can see 15-18 patients in a ten hour day, some of which includes working from home after hours. I have talked to the younger genX docs, and they are no faster than this old guy who grew up with a Bic pen as charting technology.
      The start-up costs for the hospital systems to get the EHR is around 100 million for a citywide (3-4 hospitals) system.
      I don’t think that I am a Luddite, but EHRs are clearly costly and seem to decrease productivity. Who do they serve? Have they ever been subjected to a randomized trial?
      I am a consultant. When I get a referral, the EHR is huge, and I spend a lot of time wading through it. It has not made my life easier. Everything is there, but too much data is not better than too little data.

    • I’m not a doctor, so excuse my ignorance on the matter. Are EHRs being incorporated into med school curricula? It seems to me that it will be very difficult to reap benefits (from a doc’s perspective; as a patient, I know I’ve been benefitted from EHRs, and surveys have shown consumers are pleased with them, in general) until there is widespread adoption and agreed-upon usages. It would be a long-term process, but shouldn’t that be more likely if it’s part of what every doctor learns about?

      • Let me assure you as a patient and a consumer I don’t want EHR’s. They are currently a solution in search of a problem. Or more correctly, a problem posing as a solution.

        For instance, you cannot have EHR’s and medical privacy (if it ever really existed). EHR’s are not really any more portable than paper records, and even if they were, do you think the receiving doctors will trust what is in them? Well implemented EHR’s could provide benefits that overcome their negatives. And in theory, practice is the same as theory.

    • Speaking from a different perspective, Architecture, when I first got involved in computers in the early 70’s, it was in architecture school. We were learning how to program them to support plan drafting. When we visited architects, most said that they would never use a computer. Well, it’s been 40 years and few architects don’t use computers for plan drafting, especially in larger firms.

      My point is that a lot of the resistance and/or slowness to adopt is cultural among doctors. I suspect part of the problem is lack of flexibility in the software, as it takes a while for systems to be as comprehensive and flexible as they need to be.

      Just as kids today grow up using handheld devices, there will be more and more doctors comfortable with the technology. My son is in Engineering school and they don’t even teach manual drafting anymore. Just AutoCAD. As the software improves and solves more problems, I’m sure we’ll see it in more places.

    • I love my paper record with its Problem List, Data Base, Health Maintenance Flowsheets (age 0-12, 16-62 and 64- ), and treatment plan flowsheets. We have age specific routine checkup forms, minor illness forms, and chronic illness forms (diabetes, COPD, etc). They all sit in my office wordprocessor all with immediate access for changes in immunization patterns (2-3x/yr) or office formulary alterations. What’s more, I have no down time problems and its probably less likely to disappear (as with a building fire) as compared to its electronic cousin (as with internet violations). Furthermore, I don’t have to record the race of each my patients in order to receive federal support money. There are so many assumptions about that rule that rile against my understanding of justly accessible healthcare.

    • I’m an orthopedic surgeon who has been programming electronic health records and billing software for 20 years. I marketed software in the early 1990s and I’ve built a new version (complete rewrite) in the past 4 year. I’ve learned a lot about software and its interactions with users.

      It is too bad that meaningful use became the standard rather than practical use. Practical use would have brought better acceptance by medical providers. But instead the EHR push has turned into an effort to get doctors to use government approved systems. I’ve not been able to find the criteria that the government has that leads to approval. Is this a system to give the government a backdoor to our nation’s health care records?

      And what happened to interoperablity? Did the government ever ask doctors what they needed? All I can tell is that they asked some IT professionals about what doctors would need. How would they know?

      I love my EHR. I can’t imagine practicing without it other than for short periods on locum or at a hospital with a primative system. I have no desire to pick up a microphone and start dictating. That gets errors that I have to spend time fixing.

      We need to get EHR systems programming into the hands of doctors and other providers. Otherwise, we’ll never have software that providers will be happy to use.