Death By A Thousand Clicks
EHR
report
card

March 18, 2019 -- In this excellent article, Death by 1,000 clicks: where the electronic health records went wrong, Fred Schulte and Erika Fry of Fortune magazine and Kaiser Health News (an editorially independent program of the Kaiser Health Foundation) give us a thorough look at the status of EHRs today, especially in light of the strong financial push they got from Obama's stimulus package.

Most hospitals and many doctor's offices have them now. How's it going? Were they a good idea? Well, yes and no.

There is much we could have done better. For example, George W. Bush's healthcare tech czar David Brailer said, "HITECH should have spent its $30 billion on standards, interoperability, a "Geek Squad" to help with training and implementation, and creating a cloud-based 'medical Internet'."

He's right. We were naive. 20/20 hindsight! Here are some of the main issues discussed in the article.

In some cases, EHRs have actually caused patient harm. Software glitches, user errors, and system flaws have caused orders to be lost, erroneous diagnoses and prescriptions, and many more. Deaths, serious injuries, and near misses have resulted.

EHRs facilitate "upcoding", the practice of overcharging by changing billing codes to more expensive ones. This is, of course, fraud. Settling such allegations has costed vendors more than $200 million.

Interoperability -- the ability to exchange data among EHRs so patient records could be shared with doctors and hospitals anywhere in the country -- is a promise that remains largely unmet.

Doctors (and nurses!) are burning out. Now they must spend so much of their time clicking menus and typing -- up to half of their working hours, by some estimates -- that the frustration from not instead spending this time with patients has caused many to quit. This is termed by some to be a healthcare crisis.

The EHR vendors routinely contractually obligate their customers to withhold information about product and system failures. These "gag clauses" hinder public scrutiny of safety issues and failed software installations.

My opinion: EHRs are harder to do than we thought, and our early efforts are more painful than we expected. It's a new technology, still in its infancy. It will be decades before it's seamless. But let's not give up!

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