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    Is the EHR an ill-conceived obsession?

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

     

    For drugs or medical devices to be approved, there must be evidence that benefit significantly outweighs risk. This is to protect the public. 

    A glaring exception is today’s EHRs, which were mandated by the 2009 HITECH Act.  Though never field tested and proven beneficial, these “certified” systems must be used for full reimbursement from Medicare/Medicaid. This is unlike other areas not as complex as healthcare, such as banking, which developed its electronic systems over many decades. The thrust for this imprudent rush was in part a study by the Rand Corporation, later retracted as incorrect, which promised billions in savings that have NOT materialized. 

    An internet search looking for the benefits of EHRs reveals many government sites touting their benefits, but NO scientific studies to support these claims.  Some of the benefits the government expresses:

    Assertion

    1) Enabling quick access to patient records for more efficient care

    Reality: Present EHRs have reams of superfluous information, copy/pasted out-of-date histories and physicals so as to require MORE time to assess the patient.

    2) Securely sharing electronic information 

    The “certified” EHRs from various companies do NOT share information. Also they are NOT secure, with huge numbers of data breaches.  This lack of security limits the truthfulness of patients revealing sensitive information to their physicians thereby limiting discussions for improved behavior.

    3) Helping providers improve care

    It is documented that physicians are spending most of their time meeting the requirements of the present EHRs and other administrative busy work. Our EHRs limit physician time with patients, increasing the chances of errors, disrupting the patient-doctor relationship and contributing to physician burnout.

    4) Improving patient-provider interaction

    The present EHRs and other administrative tasks are destroying the patient-physician relationship. 

    5) Enabling safer prescribing

     This was available long before the HIGHTECH Act.

    6) Promotes legible documentation and better billing

    Documentation is legible but overwhelming; the emphasis is NOT patient care, but rather a billing document.

    7) Enhances privacy & security

    Systems are being compromised every day. Data breaches, as of 2015, number over 94 million records at a cost $50.6 billion (http://bit.ly/1UAaOhu).

    8) Helping providers improve productivity

    Studies have shown that productivity is markedly DECREASED; the extra burdens of documentation are oppressive.

    9) Enabling providers’ business goals

    Efficiency is severely diminished and costs are exorbitant, greatly impeding business goals.

    10) Reduces cost

    Next: There is a solution

    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...

    3 Comments

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    • UBM User
      Unfortunately Dear Doctors are on the bottom of the food chain Working wirking their tail of to save their patients and provide for everyone else in this trillion $$ industry. The EHR companies are ONLY PEOPLE to grab the $40 Billion alloyed by the government giving the doctors nothing but but a computer with empty cells in other words Excel spreadsheets and you create data. Forcing doctors to use dragon or type or copy and paste are unsafe practices from medico -legal or for that matter a proper clear thorough record for the benefit of the patients or the providers. Perhaps the gold standard is still dictation then there, although it's a another $27 Billion industry which I tried to wipe put with new computers with new interphase for doctors which takes only few minutes to create a thorough document including boing prescriptions etc. Average if one spends cumulative time time of 20 minutes per patient, 20 patients per day will need 400 minutes of your time per day. Those of you who want to build this new intelligent computers with no key board mouse voice recognition or dictation can reach me. My goal is treat doctors as A C class executive and respect their time and value. Using such system perhaps eliminates the need for mid level people as the MD HAS TIME TO SEE MORE PATIENTS.
    • Anonymous
      The only answer to EHR's is to just say no! The only reason percent usage has increased, is that more physicians are giving up private practice in favor leaving medicine, retirement or employment by large groups and hospital associations. EHR's will be the death of private practice. On the bright side, once enough of the salaried physicians realize they can unionize and bargain collectively, they may be able improve the lot of Medicine in general.
    • [email protected]
      Very well and very logically said. In the era of "Evidenced Based Medicine" were was the evidence? When one mandates use of a "clinical tool?" that will affect every patient physician encounter, it should be evidenced based. Yes, they were obsessed with the idea that a computer improves every human endeavor. Really, just what are the properties of a computer that helps you better interview and examine a patient? In the exam room you do not need artificial intelligence. You need HUMAN intelligence that is capable of human concern, compassion, and undeerstanding

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