As of late February, 234,065 hospitals and providers had been paid nearly $12.7 billion for meeting federal standards for meaningful use of health IT, according to the latest data from CMS.
That's a lot of money and a significant number of health care providers. How much of that money has been well-spent, though? None, if you ask my wife's physician. My wife came home yesterday from a routine exam and regaled me with tales of her doctor's rant against a newly installed EHR:
"There is nothing good about this. Do you know how many physicians are leaving medicine because of electronic medical records? I came this close to retiring; this close."
Despite being affiliated with a large teaching hospital in Chicago that has helped physicians with EHR installations, the doc said the practice was "hemorrhaging money." The six-person practice had to hire staff to digitize records (my wife's electronic record was inaccurate, by the way. The doc gleefully pointed out that the paper record was correct) as well as to provide ongoing support.
She ended the outburst with this: "Who is this good for? Anyone?" I think it was a rhetorical question, but my wife pointed out that EHRs are intended to improve quality of care by giving clinicians more data at the point of care. "Humph," her physician said as she rolled her eyes (this part of the reenactment was Oscar-worthy.)
Now, if you were to ask my own doc about the return on investment for EHRs, well, he wouldn't be able to answer the question. He refuses to install one. He walks into each appointment carrying a little black book. Seriously, a little black book and a pencil. Compare that with my allergy and asthma doc who is totally digital. Her orders reach Walgreens before I even leave the exam room. Sadly, none of her notes reach my primary care doc's little black book. How's that for care coordination?
In a blog I wrote last August, ONC chief Farzad Mostashari, M.D., suggested that physician adoption of health IT should become a competitive issue. "My hope is we will see patients choosing providers on that basis," he said.
We may ultimately get to that point, but not until we address the lingering apprehension physicians have around the usability and utility of EHRs.
On a related note, there's an interesting column in March 27 Journal of the American Medical Association. Justin Starren, chief of the division of health and biomedical informatics in the department of preventive medicine at Northwestern University Feinberg School of Medicine, argues that EHRs aren't keeping pace with scientific knowledge, particularly genomics. EHRs, he points out in a statement from the school, are built for day-to-day patient care. They aren't designed to store data that isn't necessarily needed rapidly. However, he says, "An individual's genetic sequence changes little over a lifetime, but science's understanding of that sequence changes rapidly. Areas of DNA that were once considered genetic 'junk' are now known to play important roles in gene regulation and disease. We need dynamic systems that can reanalyze and reinterpret stored raw data as knowledge evolves, and can incorporate genomic clinical decision support."
Siemen's John Glaser makes a similar case for the smart EHR in a recent H&HN Daily interview.
What are your thoughts on the issue of health IT adoption? Let us know by clicking on the comment link below.