The EHR, Legacy of Obamacare

Ten years ago we argued against the way the EHR was being developed. Some idealistic left wing academic took control and had designed the rules under which this system now works. What did we say then and what is true now"

1. Patient's Records should be the Patient's Records. Instead they are the provider's records and as such when you go from one provider to another the records are inaccessible. Google and Microsoft took a swing at it but looking back who trusts them?

2. Physicians are NOT Clerks: This means that we do not want the physician spending hours entering records and finding ways to make it easier but less effective. We now have EHR staff adding to costs which are one of the reasons for increasing Health Care expenses.

3. AI cannot replace a physician. Despite Watson and all that hype there must be a human to human interface. Try placing a call to customer service anywhere, you spend a half hour with some moronic speech recognition device and usually end up at the wrong place multiple times. Patients lie, the tell you they do not drink, much, do not smoke, at least before coming to your office, do not use drugs, except for those they got from their sister.

The list can go on. In today's NY Times an author notes:

The biggest price for “digital medicine” is being paid by physicians like the sad case seated before me, who is already considering jumping to venture capital or a start-up, not because that is where the heart is but because it’s a place to bail out to. By some estimates, more than 50 percent of physicians in the United States have at least one symptom of burnout, defined as a syndrome of emotional exhaustion, cynicism and decreased efficacy at work. It is on the increase, up by 9 percent from 2011 to 2014 in one national study. This is clearly not an individual problem but a systemic one, a 4,000-key-clicks-a-day problem. The E.H.R. is only part of the issue: Other factors include rapid patient turnover, decreased autonomy, merging hospital systems, an aging population, the increasing medical complexity of patients. Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnout.

Every patient is different, most are terrified that they are dying, on the spot or soon. Many have neglected the problem that has now morphed into something more serious. The Times also showed hod US life-expectancy had lagged behind other countries. A physician today can tell you why by just looking at their waiting room. A collection of obese humans refusing to change. But how does that get to an AI system of to an EHR.

As Osler said, paraphrasing, "If all else fails listen to the patient." In today's EHR world it should read: "If all else fails look at the patient."