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EMRs Alone Will Not Transform Healthcare

It has now been eight years since the HITECH Act.   The Act distributed $35 billion for the adoption of EMRs by hospitals and physicians and established the Office of National Coordinator to adopt standards and incentives for the implementation and use of EMRs.  Yes, many now call them "EHRs" to make them seem more universal in coverage - but they aren't.

What has that achieved?  Certainly, the sales of EHRs have increased dramatically as the health provider industry took advantage of federal funds and avoided penalties by buying and installing EHR systems.  Almost every hospital in the country and most of the provider practices have purchased and installed electronic records.  There have been many stories of where EHR’s have resulted in improved clinical decision support, care coordination and improved performance.

But, according to several of critics, the benefits of this investment on patient care have been limited:

  • A 2015 article by five US Senators stated: “There is inconclusive evidence that the program has achieved its goals of increasing efficiency, reducing costs, and improving the quality of care.” Primarily because “…the lack of progress toward interoperability.”Anchor
  • The same year a report to Congress by a federal HIT Policy Committee concluded that despite large-scale adoption, significant barriers remain, including lack of cooperation among stakeholders, physician burnout tied to the technology and heavy regulation.Anchor
  • A recent commentary by several physicians concluded that “EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.”Anchor

Some of these criticisms are simply the pain of progress as traditionalists are forced into the information age.  However, they also include valid indictments of how the nation has failed to implement a national strategy to allow patients and their providers easy access to their own medical histories, regardless of where and when they received care or allowed them to control their own information. Compared to the relatively fast and widespread implementation of financial systems that allow consumers to access and control their own money as they want, when they want and wherever they are (and at almost no cost to the taxpayer), EMRs have been an elephant in the hospital room, moving at a snail’s pace.

Advocates and regulators have turned their attention from how to compel adoption to how to take advantage of the technology now that it is available.  The twisted thinking is that compelling use will solve the problem.  Compared to other innovations, this is a bit of a backwards approach toward adoption.  The “build it and then they will come” method worked in the “Field of Dreams” and perhaps for Apple’s iPhone, but not in healthcare.  Especially if the product does not allow user innovation, such as not giving the consumer ownership or making the system ubiquitous.

It's not the fault of the HIT industry.  Frankly, trying to make EMRs achieve improved quality, reduced cost or increased access alone is not the answer.  Nor are vilified meaningful use regulations.  When I was at the Appalachian Regional Commission we built hundreds of miles of roads into the isolated part of Appalachia but we knew that such infrastructure alone was not the answer – just like the Internet alone is not the answer.  We couldn’t force companies to build plants in the region just by building a road.  Similarly, making full use of technology and the information age to really improve patient care goes beyond installing hundreds of electronic record systems.

What to do?  I’ll save my thoughts for next time. ;-)

Anchor Where is HITECH’’S $35 Billion Investment Going? Sen. John Thune, Sen. Lamar Alexander, Sen. Pat Roberts, Sen. Richard Burr, and Sen. Mike Enzi. HealthAffairs Blog. March 4, 2015

Anchor REPORT TO CONGRESS, Challenges and Barriers to Interoperability. The Health Information Technology Policy Committee within the Office of the National Coordinator for Health IT. December 2015

Anchor Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records. Drs. John Levinson, Bruce H. Price and Vikas Saini. CommonWealth. May 12, 2017,

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