…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.