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Stop Throwing More Money to Fix the Problems We Created with EHRs

The move to implement electronic health records has been a major improvement.  Bob McNellis MPH., PA at AHRQ recently noted the historical expectations of electronic records: “EHRs carried tremendous promise for improving care.  Healthcare innovators envisioned a day when a primary care clinician had a patient’s latest medical history at his or her fingertips – the cardiologist’s most recent consult note, the immunizations given by the local pharmacist, a link to last month’s hospital discharge summary, and a real-time run-down of lab results.  And, oh, by the way, notes f​rom today’s visit would be sent to patients before they leave the office.”[1]

President Bush set as a goal that every American would have an electronic health record by 2014.  President Obama signed the HITECH Act in 2009, which provided over $30 billion for health systems and doctors to adopt electronic medical records.

Today, we have pretty much achieved Bush’s goal of having an electronic record for every American as well as practically every hospital, health clinic and physician’s office has an electronic record.  But now, we have too many.  Personally, I estimate that I have at least fifteen EHRs strewn throughout three or four states.  Visits over the past decade to different primary care providers, urgent care facilities, dentists, and specialists have all resulted in a record.  But of course, none are connected!  With the mergers and aquisitions in healthcare and the move by various clinical departments to implement their own system even the same institution has multiple EHRs.  HIMSS Analytics estimates that the average hospital has 16 distinct health records platforms.[2]

Today, we are awash in an ocean of uncoordinated health data.  Collecting and storing patient data has created amounts of electronic information so huge that a major problem for Chief Information Officers is how to store it all.  Dr. John Halamaka, CIO at Beth Israel Deaconess Medical Center, estimates that the average patient there will generate 80 megabytes per year (4 megabytes of text and 76 megabytes of images).[3]  No person could possibly sort through all of that information for one patient, let alone for the average panel of 2,300 patients per primary care physician.[4]

We now have a forest of large silos.  EHRs are plentiful but are solitary soldiers in the fight for health and its one of the largest drivers of increased healthcare costs.  In 2017 the American Hospital Association estimates that the cost of meeting EHR and related meaningful use requirements is nearly $39 billion per year.[5]  But it is not all costs to the healthcare providers.  One of the selling points by EHR vendors is the fact that using electronic records helps a healthcare facility or physician increase revenue by capturing costs that might have gone unnoticed and making sure they are using payment codes that yield the highest payment from insurers.  

Now that we have spawned thousands of independent EHR platforms, there is an outcry about how electronic health records need to be interoperable.  A recent survey of health providers revealed that “Ninety-one percent of the participants believed that EHR interoperability can improve clinical outcomes, and 89% said the same of fiscal outcomes.”[6]  During my tenure as CEO of the American Telemedicine Association a popular complaint was that interoperability was needed to make full use of telemedicine.  I agreed.

There are many incentives to not share data, too much interest  by vendors to create more silos, way too much complexity to create full interoperability and no business case to create it.  Its a disincentive for EHR companies and even for health systems that don't want a patient to walk out with all their records to go to a competing hospital.  We even have yet to coordinate the records between the DOD and the VA, two federal agencies that have simultaneously spent millions building electronic records to serve the same patients!  After a decade of endless spending and untold expense I am wary of the call for prioritizing efforts to fix what has already been created. 

Some are calling on spending additional millions (or billions) to develop even more standards, certifications, testing and reworking existing systems.  Others are calling for a complex framework, categories and set of procedures that sound like a consultant’s full employment program.  We do not need to spend another $30 billion to solve the problems of the last HITECH Act.

Instead, simple solutions are being developed and even available now thanks to emerging technologies.  The use of AI and machine learning can be employed to join such disparate databases into formats that can then subject to algorithms that manipulate the data and create clinical value out of the rubble for patients in particular and for healthcare in general.  Lets employ 21st Century technology to do what the government, health systems and vendors can't.

Meanwhile, the cost of healthcare services continues to grow and increasingly on the backs of consumers.  Let us allow advanced technology do the job for us and for once focus on technology and applications that actually delivers services rather than building back room frameworks and platforms.  The next $30 billion should be spent on designing and implementing services using the confluence of AI, automation and robotics and telehealth.  That would put the emphasis on directly improving care rather than just data sets.



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