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    Why are EHRs still so terrible?

    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 Keith Aldinger, MD, an internist who practices in Houston Texas. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

     

    It has been almost 60 years since Ford Motor Co. introduced the Edsel. It was designed to be a higher-end car that would compete with General Motor’s Buick. From the start, it was a dismal failure. In the years that followed, the word Edsel became synonymous with a flawed product or flawed concept.

     

    FURTHER READING: What is the price of a medical record on the dark web?

     

    In the free enterprise system, when a product fails to perform or it produces no consumer interest, it will fail. Ford respected the market forces and withdrew the Edsel from the market. Is this the way the free market system should work? Possibly not! Can you say electronic health record (EHR)?

    For some time now, the IT industry has performed remarkably well. It has given us countless technologies and electronic devices that have progressively improved over time. The industry has performed well, made our lives easier and created products that sold well in the market place. At no time has the IT industry been in need of government intervention to maintain its remarkable profitability. Then arrives the EHR.

    To put this in perspective, it is necessary to review The RAND Corporation’s study on the effects of a wide adoption of the EHR.[1] In its media office report from September 14, 2005, it stated that a wide adoption of the EHR could save more than $81 billion annually and improve the quality of care.

    Later in the report, it expands that projection with the following statement: “If the efficiency in the national healthcare system increased by an additional 1.5% per year—what economists generally agree was the impact of information technology on the wholesale and retail industry— savings could be as high as $346 billion annually.”[2]

    You can do that? You can compare the wholesale and retail industry with the practice of medicine? The last time I looked, my patients do not come in with a bar code on their sleeve. It has been said that you cannot compare apples and oranges. Yes, but at least, they are both fruits.

    Comparing the wholesale and the retail industry with the practice of medicine is like comparing apples and hand grenades. Unfortunately, the federal government has pulled the pin on the latter and tossed it into the exam room, resulting in an explosion of inefficiency and a disruption in patient care and communication.

     

    POPULAR ONLINE: Physician-designed EHRs work better for doctors

     

    This study was highly touted in Washington, D.C. and was a significant factor in the passage of the Health Information Technology and Clinical Health (HITECH) Act of 2009. This was part of the American Recovery and Reinvestment Act of 2009. This bill tossed $30 billion into the EHR trough with a deadline for physicians to adopt the EHR technology and qualify for partial reimbursement of the costs for acquiring and implementing EHR systems.

    Next: "There is a fundamental question that needs to be addressed"

    Keith Aldinger, MD
    Dr. Aldinger is an internist who practices in Houston, Texas.

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    • [email protected]
      The EHR adds 2 hours to my day and makes me see fewer patients. In it's current form it is good for prescriptions and to let the government and insurers have easy access to the data. What the ideal EHR would do the following: 1. Let the patient have their health data with them at all times-meds, labs, history, allergies etc. 2. The data would be updated with each visit and each provider the patient sees would have access to the data. These are just 2 simple things that would save billions of dollars and make the patients safer. No system does this now. Why? Are we any better off than when your doctor had your health history on 3x5 cards in an envelope? Do we really need your full review of symptoms when you had that sinus infection 5 years ago? Do we really need to kill a few more trees so you can give the patient a handout about a sore throat or sinus infection? Quality care is about information and communication. Why aren't the EHRs moving forward? All this information could now be an app on your phone!
    • Anonymous
      I have spoken to many physicians about the EHR they use, and there seems to be universal dissatisfaction with what t hey have. Many have spent large sums to replace failed systems, and have yet to find one that is user friendly and has real value. Personally, I never seem to be able to use the system in the exam room. I always need to see the patient and what reaction they have to questions. You can't do this if all you do is look at the computer screen. One other way that some practices have had to increase their expenses. They have hired scribes so they can actually talk to the patients. Is this how the feds are increasing employment options?
    • Anonymous
      I have spoken to many physicians about the EHR they use, and there seems to be universal dissatisfaction with what t hey have. Many have spent large sums to replace failed systems, and have yet to find one that is user friendly and has real value. Personally, I never seem to be able to use the system in the exam room. I always need to see the patient and what reaction they have to questions. You can't do this if all you do is look at the computer screen. One other way that some practices have had to increase their expenses. They have hired scribes so they can actually talk to the patients. Is this how the feds are increasing employment options?
    • Anonymous
      Once years ago a wise computer guru said that good software may be complex to the programmer but should be simple and easy for the user. EHRs typically require hours and hours of learning just to be able to figure out how to use them!! Thus by this definition, they are POOR!!! The only advantage of EHRs is when another user needs to see the patient's chart at a different location. This only is likely less than 5% of all outpatients! But the bean-counters have easier access to all the data now to find more ways to deny payments and regulate doctor's practices -- one of the real reasons the EHRs were forced on us! A doctor's profession is becoming just a job. - my 2 cents from a "former physician" now just a "health care provider"
    • Anonymous
      Once years ago a wise computer guru said that good software may be complex to the programmer but should be simple and easy for the user. EHRs typically require hours and hours of learning just to be able to figure out how to use them!! Thus by this definition, they are POOR!!! The only advantage of EHRs is when another user needs to see the patient's chart at a different location. This only is likely less than 5% of all outpatients! But the bean-counters have easier access to all the data now to find more ways to deny payments and regulate doctor's practices -- one of the real reasons the EHRs were forced on us! A doctor's profession is becoming just a job. - my 2 cents from a "former physician" now just a "health care provider"
    • Anonymous
      It still remains a mystery to me that anyone is surprised that government mandated projects don't work. We have Zumwalt class destroyers and F-35 fighters that don't work, continued incursions into foreign countries that don't work, and members of Congress that don't work. Even before EHR's were Health and Human Services wet dream, a Universal Patient Identifier was needed so databases would be accurate and shareable. We still don't have that and any modifications of these existing disasters without UPI is simply throwing money into an ever growing fire. The only positive thing out of this whole exercise is that it has made a lot of data storage companies and Congressmen rich.
    • Anonymous
      my private practice umbrella group switched to a new EHR making overhead unaffordable as I only practice part time; forcing me to quit.

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