Calling for an EHR evolution

By Jeff Rowe
11:21 AM

With apologies to The Bard, it seems there's no shortage of healthcare stakeholders coming to bury EHRs, these days, but not so many to praise them.

From a policymaking perspective, the commentary making the rounds is to be expected.  The HITECH incentive program has essentially run its course, so it's certainly legitimate for stakeholders and, by extension, taxpayers, to be wondering what exactly $30 billion gets you in the health IT marketplace.

But a recent commentary in the New England Journal of Medicine looks beyond a mere assessment of public expenditures to the question of whether, as the author puts it, the recent wholesale introduction of EHRs into healthcare organizations has resulted in "transitional chaos or enduring harm."

In wrestling with that question, Lisa Rosenbaum, MD, cites in broad terms a number of the well-known experiences of doctors who have essentially felt compelled to switch from paper to digital records. To wit: "Physicians retiring early. Small practices bankrupted by up-front expenses or locked into ineffective systems by the prohibitive cost of switching. Hours consumed by onerous data entry unrelated to patient care. Workflow disruptions. And above all, massive intrusions on our patient relationships."

While Rosenbaum doesn't go too far into the numbers, a recent survey by American EHR, an online community of clinicians created by Cientis Technologies and the American College of Physicians, does, and those numbers bear out Rosenbaum's overview.

For example, 42 percent of those surveyed, "thought their EHR system's ability to improve efficiency was difficult or very difficult, 72 percent thought their EHR system's ability to decrease workload was difficult or very difficult, 54 percent found their EHR system increases total operating costs."

As Rosenbaum sees it, there are a number of reasons for the belief that EHRs have essentially missed the mark. One reason, it seems, is because the "vision" of EHR proponents wasn't as clear as perhaps it should have been. "The purpose of widespread EHR adoption, as envisioned by the Obama administration in 2008," Rosenbaum notes, "was to permit a transition from volume-based to value-based payments: a digital infrastructure was essential for measuring quality. At the time, however, less than 17% of physician practices were using EHRs, and their systems often lacked necessary data-capture capabilities. Given the high up-front costs and uncertainty regarding future returns, financial and cultural hurdles to adoption were formidable."

Other suspects include confusion over the real purpose of EHRs and the perceived unwillingness of EHR advocates to listen to the early criticisms of doctors, who were readily dismissed as "naysayers."

Which brings us to perhaps the biggest problem.  As Rosenbaum puts it, "many clinicians know what they want -- but haven't been asked."  Boeing has pilots test their engineering systems, she notes.  Shouldn't doctors, the real "frontline workers", have an equivalent say in the development of what is expected to be the key tool in healthcare now and well into the future?

Lest one think such insights are limited to lofty venues such as the NEJM or the somber meetings of administrators and policymakers, we'll leave you with another take on the same issue.  It's articulated perhaps a bit more entertainingly, but it's certainly no less pointed or important for stakeholders to heed.

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