EHRs: The Problems Remain

Few issues connect such vastly different scales of health care reform as Electronic Health Records (EHRs).  How do we understand the relationship between the 30 billion dollars the federal government is investing to promote health information technology (Health IT) and the frustration of the individual physician in the exam room using that technology? The line between a good idea and implementation is clearly not straight.

In order for doctors and health institutions to receive incentive payments for Health IT they must reach federal standards known as Meaningful Use (MU).  Meaningful Use 2 was the most recent standard health care professionals were expected to meet to both get the incentive payments and avoid penalties.  (The financial incentives for achieving meaningful use status vary state by state.  Hye-Young Jung et al explain the particulars of the New York situation in a Health Affairs article on New York participation in the program.)  But of course the implementation of such standards has been far from smooth.

The AMA ‘s Break the Red Tape Project, has collected the experience of doctors with EHRs.  The key theme in these testimonials is that while the promise of EHRs is obvious, the actual EHRs that doctors are using seem to have been designed without taking into account the needs of the patients or the providers.  Dr. Katharine Phillips explains:

“The EHR wastes valuable physician time: I spend about 50% more time on each visit but less time actually looking at, talking with, and communicating with patients. It is very unintuitive and difficult to use.”

Dr. Andrea Julia discusses the lost time involved in the process of entering data and Dr. Puppala suggests that since the EHR’s were not designed around the needs of patients or physicians they can be impediment to safe care.

From the perspective of many frontline clinicians (end users as they are called in IT parlance)  many of the EHR products simply do not work well.  A recent paper by Slight et al in JMIR Medical Informatics highlights many  of these shortcomings  They point to problems in the quality and accuracy of medical lists, “nuisance alerts” that are ignored and faulty medication reconciliation systems.  They write that “the implementation of MU capabilities was reported to have stifled innovation at some organizations” for the simple reason that limited resources were used on MU criteria and not on site specific local solutions to patient and providers concerns.

If the physician problems with EHR is clear, the question is why has it been so hard to realize the promise of Health IT?  On Thursday we will explore some of the places where the promise of EHRs broke down.