Why we need to suffer the growing pains of electronic health records

My group purchased our electronic health records system (EHR) about 5 years ago.  We had 4 clinical practice locations (soon to be 5 1/2) with 1 administration office.  None of these sites are close to each other.  A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments. In other words, we wanted to know how our patients were doing in all of our offices, which treatments were working and which were not, and then use this information to refine and practice the best medicine we could. This was the promise of EHR.

And so my nightmare began.  Some of my patients define nightmare as something you didn’t wish for and it never seems to end.  Volumes could not fully describe my experiences.  I’ll just mention one “glitch”:  I noticed that some of my notes were disappearing into the “ethernet” on a seemingly haphazard basis.  Sometimes I could locate them in another section of the chart; other times I wasn’t so fortunate.  Despite my staff spending weeks trying to find the defect, we had no success.  Our vendor monitored my work processes for two weeks.  Again, clueless.  To add insult to injury, I was told that I was the only one experiencing this problem which, of course, I took personally.  Turns out the problem occurred only when I started my note before my Medical Assistant entered vital signs.  So we had the explanation, but no fix.  As a result, I wait for my MA to enter her data, which frequently delays my ability to see patients on time.  Recently, we have added 2 physicians to our practice.  One of them asked me what he was doing incorrectly that caused some notes to disappear. This time I had the answer!! What’s more, I was now informed that it was a system wide problem for which there was still no fix.

When I was a kid, there was a TV show called the Naked City.  When episodes ended, the announcer said: “There are 8 million stories in the Naked City; this has been one of them.” I do know that my story is just one among many. But it’s still so annoying.  Because of the flawed design of this particular EHR system, we have been burdened with huge financial costs resulting from lost time, the need for extra IT support, and the hardening of my right carotid artery. I don’t need the added stress in this era of decreased reimbursements for providing clinical care and chemotherapeutic agents.  One of my partners has gone back to hiring a transcriptionist rather than using the EHR.  Another is chronically behind in his data entry.  To this date, we are not set up to pool and analyze our data for outcomes.  Soon, we are beginning the gut-wrenching process of converting to a new, and hopefully more user friendly, system.

A few weeks ago, I had the pleasure and honor to have a conversation with Eric Topol, M.D. on the “This Week in Oncology” radio show. We were both intrigued by two articles that recently appeared in the New England Journal of Medicine on this subject.  The first, entitled “Escaping the EHR Trap—The Future of Health IT“, discredits the myth propagated by EHR vendors that health IT is different from industrial and consumer IT.  The authors suggest that vendors have alleged this to be fact “in order to protect their prices and market share and block new entrants.”

The second article is also quite enlightening:  “Unraveling the IT Productivity Paradox—Lessons for Health Care.” In the 1970’s and 80’s, many industries adopted computers with the expectation that they would increase productivity.  To everyone’s surprise, digitization resulted in a significant reduction in efficiency. This was called the productivity paradox.  Subsequent research revealed that productivity attributed to computerization was underestimated due to defects in measurements, mismanagement of processes (such as summarized in the “glitch” in my system above), and poor usability.  Most systems, including mine, don’t have spell-checking capability.  Unbelievable!

In chapter 7 of his must read, “The Creative Destruction of Medicine,” Dr. Topol discusses the benefits and challenges of electronic health records and health information technology in detail.  Despite the fact that digitization initially can be associated with an increase in errors, which doesn’t ease my pain, and many other challenges, he concludes:

While some may consider the topic of electronic medical records prosaic, it should now be abundantly clear that their ultimate adoption and full interoperability will prove fundamental to the future of medicine.  Only via full electronic convergence can all the tools of digital medicine be in sync and immediately useful.  With the torrent of individualized data flow that is coming from whole genome sequencing, remote physiologic monitoring, and medical imaging, electronic information storage and processing will become more essential than even envisioned today.

I have to agree with him. While this current transition period can be a frustrating, even painful experience, the alternative of a failed health care system is unacceptable.

Richard Just is an oncologist who blogs at @JustOncology.

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  • SiMBa37

    Any reason why you don’t mention the vendor specifically by name? This seems to be common among physician posts about their EHR.

    • http://violentnecessity.net Michael

      Most contracts that you must sign when “licensing” this kind of software, prohibits publicly discussing this kind of thing.

  • southerndoc1

    Strange post.
    Nothing you say supports the conclusion you reach. I’m less inclined than you are to put faith in Dr. Topol’s wet dreams.

    • http://violentnecessity.net Michael

      I agree completely. The post actually argues the opposite of the conclusion and headline.

      Frankly, we should not suffer bad EMRs and there are ways to benefit from technology without being yoked to bad software: http://scriptogr.am/michael/post/we-should-not-suffer-bad-emrs

    • Barbara Fisher

      It was a great article. Take your blinders off. EHR’s are here to stay. There is no going back.

      • southerndoc1

        Learn to read. I didn’t say EHRs are not here to stay. Just not for the “reasons” the author gives.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    There is a huge spread between the actual technology on the ground and the science fiction of possibilities created by technology. Just like all science fiction, those who describe the holographic future don’t provide blueprints for building the technology. They just assume that it will be there soon enough.
    Unfortunately, everybody else thinks that all those fictional promises are actual realities and dashed expectations are the end result. Pontificating about the evil conspiracy of existing vendors, although convenient, is not creating anything new or better either.

    So what we have now is an industry at the early stages of product development, with users expecting something that will not be available for at least another decade, and all sorts of regulators and experts slowing things down by creating false expectations and setting in stone things that should be allowed to change.
    More here… http://onhealthtech.blogspot.com/2012/08/curb-your-enthusiasm.html

    • southerndoc1

      Thanks for the link.
      Can you think of an analagous situation of mass adoption of a technology in which the primary benefits did not accrue to the user/purchaser?

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I can, but all the examples I come up with, like clean air filters for cars or environmental devices for factories, are a) mandated and b) can be argued to benefit humanity of which the purchaser (even if reluctant) is part of. I can also think of technologies that workers are forced to adopt in a workplace where there are no direct benefits to the worker.
        I cannot think of any voluntary adoption of technology that has no benefits to the purchaser/user, let alone mass adoption…. I can imagine a grim future though where this will no longer be the case.

  • buzzkillersmith

    Having an EHR without a full-time in-house IT guy to troubleshoot it is like hitting yourself repeatedly about the head and neck with a ball-pein hammer. Cheap(er), but not advised.