Thursday, June 6, 2013

The EHR: A Good Idea Gone Bad

The EHR was a good idea. Many physicians really need this once it works properly. In addition it was intended for sharing data between physicians for the purpose of lowering costs and increasing quality.

But, and this is a critical but, in my recent walks about the halls of local docs, I see the following. First, many have hired an additional staff person to type in the record. Why? Two reasons, first, they cannot figure it out, and second, the patients revolted when the doc spent all the time typing and clicking on the computer. I indicated as such early on. I had been working this issue for three decades, and still do not have a good idea what to do. Then there was that pediatrician from Boston who sat in DC and mandated an even poorer solution, in my opinion.

There is an interesting piece in Oncology Practice discussing this in an update. It states:

About 40% of physicians in the United States have adopted a basic electronic health record system, but few are able to use those systems to exchange clinical information with other offices or generate quality metrics, according to a survey of more than 1,800 physicians. 

The Harris Interactive survey found that 45% of primary care physicians and 41% of specialists met the criteria for having a "basic" EHR system, defined as a system that allows physicians to maintain problem and medication lists, view laboratory and radiology results, record clinical notes, and order prescriptions electronically. 

A much smaller portion of physicians – 10% of those surveyed – met the study’s criteria for achieving "meaningful use" of their electronic systems. More primary care physicians (11%) were able to perform all 11 meaningful use elements identified by researchers, compared to 8% of specialists who were surveyed. 

The greatest problem is transferring data in a meaningful manner.  Consider the case of a colonoscopy. At one center, an academic center, the system is almost totally computerized. The report is detailed and complete with key photos of melanosis and polyps if present. All actions taken by the physician are noted including any and all drugs and physical findings. This then gets linked to the path report. Not at a suburban clinic at best one has as a record is that the exam was performed and it was unremarkable. To add to the problem the report must be mailed to the attending! One does not even know what anesthetic was used! Were there diverticula or hemorrhoids.

Billions were spent by the current administration, or wasted if facts be known, and care decreased, costs increased, and data is jut useless.