If you hate your EHR, think it’s swallowing your information, adding hours to your day, and if you don’t watch it, you’ll make an error, you’re not a Luddite. You’re right. An exhaustive investigation by Fortune and Kaiser Health News (KHN) concludes that it’s ‘an unholy mess’. In fact, even if you are not a physician or clinical staff, it will make you wonder what was going on the collective brains of the digerati, Newt Gingrich, Barack Obama–and the US government–in thinking that EHRs would actually “cut red tape, prevent medical mistakes, and help save billions of dollars each year,” committing $36 billion to pursuing the ‘shovel-ready’ HITECH stimulus in the depths of the 2008-9 recession. Now if only those billions went towards an interoperable, useful, and national system rather than a money giveaway–which even Farzad Mostashari, then ONC deputy director and later director, now admits was “utterly infeasible to get to in a short time frame.” (Mr. Mostashari is now head of Aledade, counseling those mostly independent practices which lined up–hungry or terrified–for meaningful use EHR subsidies on how they can continue to survive.) Even the vendors were a bit queasy, but nothing was stopping HITECH. (Your Editor was an observer of the struggle.)
Now that we have been living with them for over a decade, EHRs have been found culpable of:
- Soaring error rates, especially in medication and lab results
- Increasing patient safety risks in lack of pass-through of critical information
- Corporate secrecy, enforced by system non-disclosures, around failures
- Lack of real interoperability–even with regional HIEs, which only exchange parts of records
- Incomplete information
- A very real cognitive burden on doctors–an Annals of Family Medicine study calculated that an average of 5.9 hours of a primary care doctor’s 11.4 hour working day was spent on the EHR
- Alert fatigue
- Note bloat
- Plain old difficulty or unsuitability (ask any psychiatrist or neurologist)
- A main cause of doctor burnout, depression, and fatigue–right up to high suicide rates, estimated at one US physician per day
- Lack of patient contact (why the scribes are making a good living)
- All those dropdowns and windows? Great until you click on the wrong one and find yourself making a mistake or in the wrong record.
Not even the head of the Centers for Medicare and Medicaid Services is immune. Seema Verma’s husband, a physician, collapsed in the Indianapolis airport. She couldn’t collect his records without great difficulty and piecing together. When he was discharged, he received a few papers and a CD-ROM containing some medical images, but without key medical records.
A long read for lunch or the weekend. Death by a Thousand Clicks: Where Electronic Health Records Went Wrong. Also the accompanying essay by Clifton Leaf.