EHRs: A Remnant of Obamacare

The Electronic Health Record was mandated by the ACA. It was imagined and managed by a physician from Boston and its implementation can at best be called poor. We have been opposing its implementation for a decade and have been examining it for well over three decades. Simply stated the fatal flaw was that instead of being the patient's record, it was a health provider's record of a patient and as the patient went from site to site the systems could not communicate with each other.

Now Kaiser presents a sad tale of how this thing has started to cost lives. They note:

But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment. KHN and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it. By one measure, certainly, the effort has achieved what it set out to do: Today, 96 percent of hospitals have adopted EHRs, up from just 9 percent in 2008. But on most other counts, the newly installed technology has fallen well short. Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them — which is more than the hours they spend with patients. Unlike, say, with the global network of ATMs, the proprietary EHR systems made by more than 700 vendors routinely don’t talk to one another, meaning that doctors still resort to transferring medical data via fax and CD-ROM. ­Patients, meanwhile, still struggle to access their own records — and, sometimes, just plain can’t. Instead of reducing costs, many say, EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in “upcoding” or bill inflation (though some say the systems also make such fraud easier to catch).

In my opinion it is due to the gross incompetence of the Government and the influx of politically motivated individuals into this system. As noted, I can use my bank card in almost any country in the world. Get off a flight in Paris, go to a Kiosk, get Euros, stop at an ATM in Nova Scotia and get Canadian dollars. Fast, secure, interconnected. Not the EHR.

It had added a burden to every physician. There is now another employee sitting there typing into a computer hopefully getting it right. Or the physician is looking at the screen typing away as the patient wonders if they hear them.

I believe these systems can be a tremendous support to physicians. However as currently embodied, by law, they are a disaster. As noted, I cannot access images. If I did a CAT in location one and an MRI at location two then it is unlikely I could do a correlation. I would have to take everything to location 3!

Worse, a key to patient care is looking for trends and changes. I would watch blood sugar, HbA1c, weight, creatinine, etc. The systems for the most part still enter and display by visit, not by patient history. Generally if nothing changed you are fine, if it is changing, I would try to find out why and then see if that is normal. Not with any of these systems.

Finally, any Government mandate and designed system is subject to massive flaws. So now you want Universal Medicare! They can't get the trains to run on time.