HIT experts warn about EHR investment in open letter to Obama

Two healthcare information technology experts have penned an open letter to President Obama, warning him against investing too many federal dollars in existing electronic health records systems.

Existing EHR systems are too expensive, difficult to implement, disruptive to practice workflows, not proven to improve patient care, and don’t do a good job of sharing information with each other, wrote David Kibbe, MD, a technology adviser to the American Academy of Family Physicians, and Brian Klepper, PhD, founder of consulting firm Health 2.0 Advisors.

“If America’s physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the Babel that already exists,” Kibbe and Klepper wrote.

Obama is expected to include some form of financial assistance for EHR systems as part of an economic stimulus proposal that could reach $850 billion in total. “We will make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year,” Obama said in a December radio address.

A bill under consideration in the U.S. House of Representatives calls for incentive payments up to $41,000 over five years beginning in 2011 for physicians who adopt EHR systems. But the provisions of that bill could change substantially by the time the legislation is finalized.

While Kibbe and Klepper say that “some” federal health information technology dollars should go to EHRs, they advocate spending the majority of the funds on what they call “smaller, incremental steps” that would help patients while minimizing the disruption to doctors. Specifically, they call for federal funding that would increase the adoption of electronic patient referrals, and online “patient portals” that allow for electronic communication between doctors and patients, as well as the build-out of broadband infrastructure that would connect rural and low-income patients to healthcare providers, according to the letter.

Further, investment in those areas, while withholding large subsidies for EHR systems, would come with the added benefit of sending a cue to EHR vendors, the letter’s authors say. “It would signal [to] the EHR industry that, for national deployment, they need to come to terms with issues they have avoided so far, like interoperability and cost,” Kibbe and Klepper wrote.

Joseph Scherger, MD, a clinical professor at the University of California, San Diego, and HIT expert, says he agrees with Kibbe and Klepper that the majority of federal HIT funding should not go to existing EHRs. “These funds should not be used to support an industry that is overpriced for the quality of its products,” he says.