Is the EHR an ill-conceived obsession?

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

For drugs or medical devices to be approved, there must be evidence that benefit significantly outweighs risk. This is to protect the public. 

A glaring exception is today’s EHRs, which were mandated by the 2009 HITECH Act.  Though never field tested and proven beneficial, these “certified” systems must be used for full reimbursement from Medicare/Medicaid. This is unlike other areas not as complex as healthcare, such as banking, which developed its electronic systems over many decades. The thrust for this imprudent rush was in part a study by the Rand Corporation, later retracted as incorrect, which promised billions in savings that have NOT materialized. 

An internet search looking for the benefits of EHRs reveals many government sites touting their benefits, but NO scientific studies to support these claims.  Some of the benefits the government expresses:

Assertion

1) Enabling quick access to patient records for more efficient care

Reality: Present EHRs have reams of superfluous information, copy/pasted out-of-date histories and physicals so as to require MORE time to assess the patient.

2) Securely sharing electronic information 

The “certified” EHRs from various companies do NOT share information. Also they are NOT secure, with huge numbers of data breaches.  This lack of security limits the truthfulness of patients revealing sensitive information to their physicians thereby limiting discussions for improved behavior.

3) Helping providers improve care

It is documented that physicians are spending most of their time meeting the requirements of the present EHRs and other administrative busy work. Our EHRs limit physician time with patients, increasing the chances of errors, disrupting the patient-doctor relationship and contributing to physician burnout.

4) Improving patient-provider interaction

The present EHRs and other administrative tasks are destroying the patient-physician relationship. 

5) Enabling safer prescribing

 This was available long before the HIGHTECH Act.

6) Promotes legible documentation and better billing

Documentation is legible but overwhelming; the emphasis is NOT patient care, but rather a billing document.

7) Enhances privacy & security

Systems are being compromised every day. Data breaches, as of 2015, number over 94 million records at a cost $50.6 billion (http://bit.ly/1UAaOhu).

8) Helping providers improve productivity

Studies have shown that productivity is markedly DECREASED; the extra burdens of documentation are oppressive.

9) Enabling providers’ business goals

Efficiency is severely diminished and costs are exorbitant, greatly impeding business goals.

10) Reduces cost

Next: There is a solution

A statement retracted by the Rand Corp. MORE busy work limiting patient-physician face time increases errors and cost. Duplication of testing was a major selling point of the push to prematurely adopt these systems.  The supposed costs of testing duplication are vastly exaggerated, as artificially high charge-master and NOT cash prices were quoted. Also, storing test results on the cloud is vastly cheaper.

 It is clear that these benefits touted by the federal government are vastly exaggerated if not blatantly false. Yet, our government persisted with passage of MACRA, touting that more information could determine quality. This assertion has never been rigorously tested. Individual patients should determine quality, NOT third parties. It is impossible to mass-produce medical care. Every attempt to do so has sacrificed quality and increased costs. Information the government thought important could be requested to be included in any program physicians would acquire on an open market.

The cost of implementing the 2009 mandated HITECH Act programs is staggering.  Many hospitals had to discard their previous EHRs and start over to meet the new requirements. Henry Ford Health System spent $353 million over three years. University of Vermont system plans to spend $150 million over the next three years. Prices for conversion to Epic EHRs vary wildly from $43 million to $1.2 billion. Amounts for all the approximate 5,000 private hospitals in the country are hard to obtain, but it certainly is in the range of many hundreds of billions of dollars. This does not include yearly maintenance fees.

Federal health facilities have spent or plan to spend huge amounts. The Department of Defense signed a contract worth about $4.3 billion, which could eventually cost up to $9 billion. The Veterans Department, plans to use the DoD Cerner platform, but with modifications that will allow integration with other sites. Cost, not mentioned, but must be in the billions. 

Add to this amount the yearly cost per physician, about 800,000 practicing physicians in the U.S. times $30,000/physician equals about $24 billion. As an inducement, by 2015 CMS has paid out about $30 billion.

The evidence is overwhelming: Our government has forced upon the healthcare system an overly expensive EHR regimen that is in no way meeting the stated goals.  Even worse, these demands are severely compromising the care of our citizens. This is evidence that our government is obsessed with a concept that is not ready for prime time.

However, there is a solution. Use the cloud for test data for minimal payment. Allow physicians to seek EHRs on the open market that enhance the patient-physician relationship rather than impede it. This would encourage innovation and entrepreneurship. Release physician time to care for patients, rather than clerical and busy work. Overall costs would decrease.