Whether you know it or not you are participating in -- and paying for -- a huge experiment that is transforming how medicine is practiced.
In 2009 the federal government, with little input from practicing physicians, determined the country should adopt electronic health records.
The promise was that eliminating pen and paper would improve efficiency: All your medical information could be instantly retrieved, sharing information among caregivers would take seconds, and quality of care could be easily monitored. The notorious inability of doctors to write legibly would no longer matter. Patients could even access their records from home. All this while saving money.
To facilitate the transition the government offered almost $30 billion of financial incentives for those doctors and hospitals that began using and showed “meaningful use” of the electronic records. Soon those who do not adopt EHRs will face penalties in the form of decreased Medicare and Medicaid reimbursement rates. It is estimated that half the doctor’s offices and three quarters of the hospitals have made the transition.
To the surprise of few doctors, the transition has been far from smooth.
Recently I was with a friend who was being admitted to a hospital for a possible heart attack. The admitting nurse had her back turned to him for long periods of time while she entered his information into a computer. When I suggested this was insane, I was firmly told she wanted me out of there, now. I left, marveling how much medicine has changed.
This is what is most upsetting to me and many other “old timers” -- the way it has transformed the relationship between doctors and patients. I was taught to sit facing patients, make eye contact, observe them carefully, and do the charting afterward. Now it is considered acceptable to feed the data directly into a computer as you are collecting it. After all you will be judged by how well you satisfied the needs of the computer, not by how well you interacted with the patient.
Medical “scribes” -- people who will shadow doctors and enter the data under their supervision -- have been suggested as a partial solution to this problem.
Even with the incentives, expenses can be overwhelming. Purchasing a system, transferring the old records into electronic format, training and updating staff on its use can overwhelm solo practitioners and small practices. This has forced many to lose their independence and merge with a local hospital network that can supply technical support.
There are more than 700 certified vendors to choose from and amazingly, the information from different systems cannot be shared.
Many users find the systems frustrating to use. It can be time consuming and cumbersome to navigate multiple screens and multiple drop down menus to perform the simplest task. Tracking down all the information needed can be difficult. Simply cutting and pasting previous notes has become a significant problem as practitioners look for ways to minimize their computer time.
Security is another concern. The seemingly endless supply of news stories about security breaches does not inspire confidence. And of course there is the issue of what happens if there is a computer problem. Actually that’s easy: you’re out of business until it’s fixed.
Maybe someday a generation of doctors who grew up using smartphones will get the whole system to work as planned. That day is not today.