Another dirty little ObamaCare secret is out of the bag. Electronic health records (EHRs) are not what they’re advertised.
Electronic health records are digital versions of a patient’s medical chart. In the 2009 stimulus bill, prior to passage of the Affordable Care Act, the Obama administration instituted a mandate that all medical providers that accept Medicare must adopt EHRs by 2015 or suffer fines. Beginning in 2015 the fines are 1% of all Medicare bills increasing to 5% in the next ten years.
Electronic Health Records Myths
The excuse for this unprecedented intrusion into the practice of medicine was a series of myths that purported to explain the necessity of this mandate. Among these myths were the following:
- Reducing medical errors
- Increasing the efficiency of medical practices
- Lowering the costs of healthcare
- Improving the quality of healthcare by delivering “evidence-based medicine”
My own experience refutes all of these claims. When my local hospital instituted EHRs I found an increase in medical errors due to nursing mistakes or computer errors, a decreased efficiency in the routines of hospital care and treatment of patients, an increase in the costs associated with providing care for personnel and technology, and no evidence of improved quality. I conducted my own non-scientific surveys of my colleagues and found they had similar experiences.
Then I attended a seminar for orthopedic surgeons conducted at a nationally recognized orthopedic association intended to convince doctors to install EHRs in their private practices. The panel of four orthopedic surgeons began the seminar by listing all of the benefits of EHRs. They were all advocates. But three hours later, after the Q & A session, they had admitted in careful questioning by the audience that every one of the “benefits” did not exist! Efficiency was worse, costs were higher, personnel needs were greater, and there was no evidence of improved quality. I decided then I would not install EHRs in my practice.
Now my impressions have been corroborated by an article in The Wall Street Journal written by Jeffrey A. Singer, a general surgeon in Phoenix and an adjunct scholar at The Cato Institute. Dr. Singer says the Department of Health and Human Services initiated a five-year pilot program in 2008 to study the problem in 12 cities and states. But then, one year later, they moved forward with the mandate without sufficient evidence, ignoring the possibility that what worked for Kaiser or the VA might not work in the private practice of medicine.
Singer says EHRs are contributing to two major problems:
- Lower quality of care
- Higher costs delivering care
The former is caused by the attention-dividing nature of EHRs. They force the physician to physically turn their attention away from patients and toward the input of computer data – a shift from individual care to IT compliance. This may be ameliorated somewhat by having an assistant input the data instead – but this further increases the costs of delivering care.
A 2014 survey by the industry group Medical Economics discovered:
- 67% of doctors are “dissatisfied with EHR functionality.
- 73% of the largest practices would not purchase their current EHR system
- 45% of respondents say patient care is worse
- 65% of respondents say their EHR system results in financial losses
In my own experience at the seminar, doctors reported their caseload for an average day was reduced by 50%!
Three of every four physicians surveyed by Deloitte said EHRs “do not save time.” Doctors reported spending – or more accurately, wasting – an average of 48 minutes each day dealing with the system.
The Deloitte survey also found that three of every four physicians think EHRs “increase costs.” Three reasons are given for these increased costs:
- Physicians can no longer see as many patients per day – Higher prices are charged to compensate for lost revenue.
- High implementation and maintenance costs – Agency for Healthcare Research and Quality reported the average five-physician primary care practice would spend $162,000 for implementation – and another $85,000 in first-year maintenance.
- Small practices cannot compete – and sell out to hospitals – Hospital charges for the same services are higher.
Last, but not least, is the issue of medical errors. EHRs were promoted originally as a means to reducing medical errors. The Institute of Medicine claimed in 1999 as many as 98,000 lives were lost each year due to medical errors. With this “moral high ground” it was difficult as a physician to resist the pressure to comply.
But now a recent study in Perspectives in Health Information Management found that EHRs encourage errors that can “endanger patient safety or decrease the quality of care.” America witnessed a real-life example of this during the recent EBOLA crisis, when “patient zero” in Dallas, Thomas Eric Duncan, received a delayed diagnosis due in part to problems with EHRs.
This issue has received little attention in the ObamaCare debate. But it is time that Republicans considering improvements in our healthcare laws bring an end to the mandate for EHRs. They may have been instituted with good intentions, but time and experience have proven they do not live up to their promised benefits.