Monday, October 14, 2013

EHRs and Excrement




As far back as 2005 I  pontificated about the misdirection and poor design of EHRs.  Ethnology was and is uppermost in my attitude about electronic medical record systems.

Human-Machine interfaces are critical for accuracy, and efficiency. Not only is a poorly designed H-M interface (call it a GUI if you must) a liability it drastically alters good clinical practices. It greatly increases fatigability and frustration for users.  Most important is that it disrupts the face-face provider bond eye to eye contact.  No patient is going to believe a provider is interested in them when the provider is  staring at a computer screen or waiting on the PC to catch up. 

EHRs do not simplify nor make a broken practice work better. That used to be an important criteria. Today the feds have muddled an already hazy future for HIT, with incentives, penalties, meaningful use criteria.  All these meant to rush acceptance of HIT which is not ready for prime time.  As usual HHS has primed the pump for more rapid medical inflation (despite their unending programs to ‘flatten the cost curve of health care)

I see a future with greatly increased costs for health care with mandated HIT. The incentives are an example where it will backfire on the  providers who naively accept it, .

Perhaps the system can spin it as cost saving device,but for whom"?  I see my overhead rising and rising.

Darwinian health IT: Only well-designed EHRs will survive


Medsphere Systems Corporation  Edmund Billings, MD, is the chief medical officer for Medsphere Systems Corporation

Recently Dr Billings wrote about EHR dissatisfaction in HealthCare IT News

Health IT assumes healthcare will buy what we’re selling because the feds are paying them to. And, like the Pinto,and the Edsel what we’re selling inspires something less than awe. In short, we are failing our clinical users.

Myopic efforts to meet certification and compliance requirements have added functionality and effort tangential to the care of the patient. Clinicians feel like they are working for the system instead of it working for them. The best EHRs are focused on helping physicians take care of patients, with Meaningful Use and ICD-10 derivative of patient care and documentation.

Dissatisfaction is increasing regardless of practice type or EHR system. These findings highlight the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient work flows, improve error rates and patient care, and for practices to recognize the importance of ongoing training at all stages of EHR adoption.

Additional survey results show dramatic and pervasive dissatisfaction:

  • Clinicians who would not recommend their EHR to a colleague increased from 24 percent in 2010 to 39 percent in 2012.
  • 34 percent of users were “very dissatisfied” with the ability of their EHR to decrease workload — an increase from 19 percent in 2010.
  • 32 percent of responders had not returned to normal productivity since EHR implementation compared with 20 percent in 2010.
  • Dissatisfaction with ease of use increased from 23 percent in 2010 to 37 percent in 2012.
  • Satisfaction with ease of use dropped from 61 to 48 percent.

According to Modern Healthcare, natural selection may already be taking place in the EHR environment as Meaningful Use 2014 and Stage 2 introduce more exacting requirements. The magazine’s review of federal records shows a massive drop in the number of health IT systems being tested for Stage 1 2014 and Stage 2 certification.  While around 1,000 EHR technologies were certified for 2011 Stage 1 requirements, as of last week only 79 systems were certified for 2014 standards. Almost all companies are scrambling. Some will get certified in time. Many more won’t.  What will current users do if their systems are not upgraded to Stages II-IV? How much will it cost them?


This is just the beginning of the shakeout … there is an asset bubble in electronic health records and health IT,” said Dr. David Brailer, founder and CEO of Health Evolution Partners and former head of the Office of the National Coordinator for Health Information Technology.

“The data suggests that it is likely we’ll see a sizable reduction in the number of EHR vendors listed for 2014 edition certification,” predicted Steven Posnack, director of federal policy, and Dustin Charles, a public health analyst, on the ONC’s September 13 blog post

MU is not really about patient care.  It’s about data which HHS claims will improve outcomes.


At the end of my day, it is what it is….millions of man-hours have gone into what we used today.  It is going to take time to hew out the bad, smooth out the rough edges, fill in the potholes….and if all goes well we will most likely have bankrupted the health  system (to say nothing about the Affordable Care Act.)


In one of my upcoming blogs I will discuss the ICD-10.


No comments:

Post a Comment