This blog post was featured on Linkedin’s industry feature “pulse” page on April 3, 2019. David Lareau is CEO of Medicomp Systems.
“Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money.” – from “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong” by Fred Schulte and Erika Fry, Kaiser Health News and Fortune magazine
- Few health IT veterans were shocked by the revelations documented in the recent KHN/Fortune article, “Death by 1,000 Clicks: Where Electronic Health Records Went Wrong.” Both clinicians and health IT professionals are well-aware of the anticipated benefits of digitizing medical records, as well as the numerous shortcomings that continue to threaten patient safety and impair physician satisfaction.
As an industry insider peering into the rear-view mirror, it’s not difficult to understand where EHRs went wrong (or as the article authors said, where they became an “unholy mess.”) And as a firm believer that EHRs still hold great potential to make healthcare better, I’d like to offer some thoughts on fixing EHRs where they hurt.
But first, here’s a quick review of how we got to where we are today.
A “mess” 10+ years in the making
In 2009, the country was in the midst of an economic crisis. In an attempt to kickstart the economy, the federal government passed the American Recovery and Reinvestment Act (ARRA), which included a funding provision to accelerate the digitization of medical records.
ARRA was designed to quickly pump money into different segments of the economy. The government focused on initiatives that were already under consideration, such as promoting the adoption of EHRs. By many measures, the resulting EHR “Meaningful Use” program was a success: between 2008 and today, EHR adoption by hospitals has jumped from 9 percent to 96 percent, and adoption by office-based physicians has climbed from 40 percent to 86 percent. To date, the government has paid providers $36 billion for their efforts.
The Meaningful Use program was flawed, however—in part due to its hasty creation. The architects didn’t have adequate time to create a detailed roll-out plan to drive better patient care. Instead they designed a program that prioritized economic stimulation and established a low bar for the adoption of EHRs.
To qualify for funds, providers needed to adopt EHRs in a relatively short time frame. Most EHRs at the time were designed to drive billing transactions and not to facilitate better patient care. As more providers adopted EHRs, vendors were forced to prioritize enhancements that helped clinicians qualify for Meaningful Use requirements, rather than R&D updates to improve EHR functionality. Over time, EHRs have largely become digitized versions of paper medical records, rather than tools to enhance the delivery of safe and effective patient care.
The current landscape
Today EHRs store massive amounts of clinical information, yet much of it cannot be easily accessed by clinicians at the point of care. Despite the digital revolution, we have largely failed to equip clinicians with systems that support clinical workflows and align with physician thought processes. Instead, we have given clinicians huge blobs of data that are not logically integrated and require users to sift through records to find the details relevant to an individual patient and the patient’s specific problem.
Several years into the Meaningful Use program, administrators decided it was time for clinicians to use all this electronic data to manage chronic conditions, coordinate care, and help reduce the cost of care. To qualify for various incentives today, providers are expected to track and report on specific quality measures using their EHRs.
While commendable in theory, the reality is that few EHRs offer well-integrated workflows to support these activities. In the absence of functionality that supports an on-demand and holistic view of a patient at any time, clinicians must resort to the time-consuming task of flipping through EHR screens to locate the information they need.
First, do no harm
Every medical student is familiar with the Hippocratic Oath, which includes the promise to do no harm. When it comes to clinical IT solutions, I believe we also must extend this promise and also commit to providing clinicians the tools they need to perform their jobs—while further committing to staying out of their way.
In other words, as health IT professionals, we must provide clinicians tools that are designed to support—and not hinder—their workflows. The most powerful computer in any treatment room is the clinician’s brain—and it’s essential that we give clinicians the time and mental space to actually think about the patient in front of them, rather than forcing them to sift through pages of electronic data.
Unless we commit to empowering clinicians with tools that deliver all the relevant information they need in a click or two, we are not going to realize the potential for EHRs to drive safer, more effective patient care. Instead, we are going to continue to fuel clinician burnout and fail to fix our flawed clinical systems.
Righting EHR wrongs
We can’t fix all that is wrong with EHRs overnight. However, as we consider strategies to right the EHR ship, I recommend inclusion of the following:
· Eliminate data blocking. If we hope to bend the cost curve, make healthcare safer, and improve patient outcomes, we must provide clinicians access to a patient’s complete record. Providers and vendors, many of whom fear losing market share, cannot be allowed to block data-sharing efforts.
· Seek clinician input. If we want clinicians to embrace EHRs, we must incorporate input from clinician users. Clinician input is essential for designing workflows that enhance patient care and physician productivity and give users the information they need when and where it’s required.