…shot to hell. At Forbes Sally Pipes reports on the results of implementing electronic health records (EHR), one of the provisions of the Affordable Care Act:
The EHR push started with the 2009 American Recovery and Reinvestment Act. President Obama approved billions in spending to encourage the healthcare industry to embrace the technology. Doctors and hospitals who failed to adopt a government-approved digital system by the end of 2014 faced cuts in their Medicare reimbursements.
So providers rushed to implement EHRs. Ninety-six percent of hospitals have EHR systems today, up from 9% in 2008. Most doctors adopted them as well.
But these EHRs ended up being seriously flawed—and dangerous for patients.
For one, patient records routinely have errors. In one survey, 21% of patients reported mistakes in their own electronic medical records. In some cases, when a physician pulls up a patient profile, the system displays a doctor’s note for a different patient.
Other issues abound. Systems are supposed to flag potentially dangerous drug orders but often fail to do so. Records frequently don’t list the correct start and stop dates for prescriptions. And transmitting data between systems is a huge challenge.
Consequently, the recent Fortune-KHN investigation revealed, “alarming reports of patient deaths, serious injuries and near misses—thousands of them—tied to software glitches, user errors and other flaws.”
More than 3,000 medication errors at pediatric hospitals from 2012 to 2017 were due in part to EHR problems, a study in Health Affairs found. About one in five of these could have caused patient harm.
A 2016 test simulation of hospital EHRs revealed that, in roughly four in ten cases, the system failed to detect potentially harmful drug orders. Of those, 13% could have been fatal errors.
I take a sort of perverse satisfaction in seeing that just about everything I have predicted about EHR has actually happened. Back in 2010 or 2011 I recounted the story of the presentation by an EHR vendor to one of my physician clients. At the conclusion of the horrifically arrogant presentation and after the vendor had left, I turned to my client and said “You were much more polite than I would have been. I would have thrown him out a half hour ago.”
Good systems and health care are not a congenial match. It is rare indeed that a system is designed following an industry-wide study of needs and practices. What is much more common is that systems will be what is easy to implement, what is fashionable, what a single client would pay the designers or implementers for, or whatever sticks against the wall. I haven’t look at EHR systems for a while but I would predict that today’s systems have all sorts of glossy claims about artificial intelligence, blockchain, and other buzzwords du jour.
I have looked casually at the systems being used by my wife’s health care providers and so far all of them have been ghastly. Any system in which the physician, PA, or nurse is tethered to a monitor and keyboard IMO is a failure.
Regardless, I think that EHR systems have tremendous, largely unrealized potential. It will take a while before it is realized.
The problem with EHRs is that they are designed for billing and to make administrators happy. Even then they can be lacking. The reports generated from EPIC are pretty sucky. If I want to track data from our department I have to use a secondary reporting tool. (My IT guys says EPIC will soon have available a new reporting tool which is a lot better.)
All that said, EHRs are disappointing from the POV of what they could be. In terms of what they actually do, my sense is that they are a lot better than what we had before them, at least for EPIC. Look at this quote form your piece.
“More than 3,000 medication errors at pediatric hospitals from 2012 to 2017 were due in part to EHR problems, a study in Health Affairs found. About one in five of these could have caused patient harm.
A 2016 test simulation of hospital EHRs revealed that, in roughly four in ten cases, the system failed to detect potentially harmful drug orders. Of those, 13% could have been fatal errors.”
Before EHRs there was nothing that was available to spot those errors other than the end user. So the 60% of the time when the EHR caught errors is a big improvement. People forget that paper records were incredibly incomplete and usually illegible.
“I would predict that today’s systems have all sorts of glossy claims about artificial intelligence, blockchain, and other buzzwords du jour.”
Not with EPIC. Their big claim is that the product is customizable for the user. They also keep claiming the EPIC should not dictate workflow, that workflow should follow EPIC. I probably have 3 or 4 meetings a month because of issues when this is not true, or when EPIC insists that we have to use their terminology.
Steve
I’m probably speaking from ignorance here, but why couldn’t a consortium or other organization of stakeholders or experts create a standard for EHR’s like we have standards for just about everything else in IT?
I have some funny stories about standards committees.
Actually, there are such standards, Andy. They cover authentication, interoperability, data transmission, and so on. Sadly, standards don’t guarantee a good system.
I’ve heard and read the most frequently cited reason physicians are burning out on medicine is the use of electronic health records. According to many EHRs depersonalize and take away from doctor/patient relationships and interaction times.
That’s not inherent to EHRs. It’s a result of their poor user interfaces. There’s no necessary reason for an EHR to be any more depersonalizing than a notepad is.
Ballou and Alexander, IIRC, started the trend towards blaming EHRs, but burnout as a problem existed before EHRs were prevalent. I think that they are just one piece of a broader problem. If you read many articles on burnout you will find many opinions on the root causes. My take away is that first, some doctors are wimps and many went into medicine with unrealistic expectations. They really thought those TV shows were true. You really dont save a life every day. A lot of patients are abusive or jerks. There is a lot of emphasis on money. The doctors that make the most money are usually coddled, sometimes to the point of placing their wishes ahead of good patient care. Meh, grow up. It is a job, but it is still a good one and there are still tons of opportunities to make a difference if you want to do so. If you grew up in an upper middle class family and it never occurred to you that you were going to have to keep working hard even after you left training, well much of the world works pretty hard. People who grow up poor understand that intuitively. If you grew up balancing tennis lessons and having your chemistry tutor show up on time this will be a real wake up. Welcome to reality. (While my N is small, I dont think I have ever seen a doc who grew up poor or working class who went through burnout.)
Next, I think lack of good leadership is almost always a root cause of burnout. Lack of autonomy and too much interference in care as often cited as causes of burnout. If physicians would put in the effort to make sure that they are involved in leadership that is much less likely to happen. Too many docs are willing to work for hospitals and not willing to put in the work or take the risk to run themselves. (Ok, I will concede that in the really big mega-networks the harm is already done and it will be darn difficult to take it back.)
Finally, while I think burnout is a real problem, I am troubled about the treatments. When I have searched for help with the problem, most of what I read sounds like touchy-feely nonsense.
Steve
I agree with just about everything steve wrote above and I would add that we are selecting physicians for the wrong qualities. They may have been the right qualities a century ago or fifty years ago or twenty-five years ago but those qualities are becoming less relevant every year. It’s no wonder physicians are dissatisfied. They want the wrong things.
Forgot to add this interesting piece on EHRs. The people I work with who seem the least bothered by EHRs are those who spent the time to get really good at them. They have everything customized.
https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0039-1688753
Steve