EHRs: Promises to Keep

In the last Blog we explored some of the problems physicians have with EHR (Electronic Health Record) systems.  But why is it so hard to find EHR’s that do the job well?

One problem in the EHR market is that it is a challenge at best to have EHRs up and running by the compressed schedule set by CMS.  A second issue is that there are simply a limited number of products that comply with meaningful use standards, each with its own set of drawbacks as reported on by a recent review of vendor products out by The American Medical Association and MedStar Health’s National Center for Human Factors.  

The problem of Interoperability or the ability of different EHR systems to share information with one another is a massive problem in realizing the promise of Health IT.  Again, while it is hard to disagree with the wisdom of sharing information among providers, unfortunately in the real world of EHRs this is often impossible to do.  Furthermore interoperability needs to take place within a competitive healthcare market.  A recent article in Mother Jones by Patrick Caldwell “Epic Fail” argues that competitive pressures in the healthcare marketplace impedes the goal of universal interoperability.  Caldwell is especially critical of EPIC ,the largest EHR vendor. He writes:

“But instead of ushering in a new age of secure and easily accessible medical files, Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. “

Specifically, Caldwell highlights a practice known as  information blocking which is also explained in a Health Affairs Blog post.  In short, the need for venders to profit on EHRs does not always align with the patient interest.  For the providers, complete sharing of EHRs across platforms holds out the promise for the highest quality and safest care.  But it is not clear, as the Mother Jones article explains, that such interoperability is to be expected from venders seeking market share at the expense of their competitors. The blog post quotes from a Office of the National Coordinator for Health Information Technology (“ONC”) report that explains the conflict between competitive market pressures and the public good:

“[…] some business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns. At some point, ONC believes that decisions to engage in such practices are unreasonable as against public policy […]”

The problem that we are outlining and which can be viewed in many areas in medicine is the disconnect between idea and implementation.  Like the children’s game of telephone, something is lost between the 30 billion investment and the patient’s visit to the doctor.

At Doctors Council we argue that what is missing is the serious engagement and use of front line knowledge in the development and deployment of IT used in the healthcare system.  The problem is not simply to get “input” from doctors, but rather how to reverse the flow of information so that ideas born in the clinical encounter can be scaled up, and produce an EHR that doctors both need and will welcome. We need EHRs that will benefit patient care and not be viewed as an impediment to the doctor-patient relationship (or time spent with a patient).