Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A positive view of health reform, no thanks to the HITECH Act

Kohar Jones, MD
Tech
June 3, 2015
162 Shares
Share
Tweet
Share

Recently I completed the Commonwealth Fund’s 2015 International Survey of Primary Care Doctors. They wanted to know what I thought about our health system; if fundamentally it worked or needed to be better. They asked questions about my satisfaction with practicing medicine, the quality of care my patients receive, and my experiences with electronic medical records. (You can click here to read through the 2012 survey, to get an idea of what it’s all about.)

Their final question was about health care reform.

“Thinking about the health care law that was passed in 2010, also known as the Affordable Care Act (ACA) or Obamacare, would you say that you have a very favorable opinion, somewhat favorable opinion, somewhat unfavorable opinion, very unfavorable opinion, or not sure.”

And I realized, as I answered this:

That I have a somewhat favorable opinion of the Affordable Care Act. It is good for patients to have access to health insurance, even though there are ongoing and severe issues with access to care.

I have a very unfavorable opinion of the much-less-talked about HITECH Act, that rolled out about the same time as the ACA, and which has profoundly shaped physician practice and patient access. The HITECH Act pays doctors to use electronic medical records in a meaningful way in order to spur the widespread adoption of EMRs. But it didn’t provide any oversight of the EMR market to ensure that the EMRs could provide meaningful functionality in an efficient way.

When we used paper charts, I used to be able to comfortably see 24 patients and finish charting by the end of the day. Now with the suboptimal EMR adopted by our health center, I can barely see twenty, and I have to spend extra hours on evenings and weekends finishing computer charting. Sadly, the EMR hasn’t added clinical functionality beyond what paper charts did — each system is still fragmented, I can’t access records from specialists’  offices or most hospitalizations, lab results may or may not be integrated into the system, radiology reports are scanned in — only now I have to slowly click through each separate screen, rather than riffling through a chart to find what I need. A colleague described the process: “Death by a thousand clicks.”

I am not alone in taking longer with EMRs. A 2014 study in JAMA Internal Medicine showed that, nationwide, physicians average an additional 48 minutes a day charting when using EMRs. When it take physicians longer, we take, on average 2 hours longer each day. But there are outliers — two-fifths of physicians are taking the same amount of time, or less. 2 percent even report being much more efficient! What I want to know are — what EMR products are the physicians using who find EMRs equal to or more efficient than paper charts? And can I use those too?

Not all EMRs are created equal. I have worked with three different systems since residency — one was awesome (integrating records across a county system), one was equivalent to paper (same amount of time to chart, but same challenges in accessing records from different systems adopted in the ED, inpatient, outpatient). This last EMR has been terrible. Of the hundreds of products on the market, some EMRs are more efficient than others, and deliver on the promise of improved functionality. Sadly, those are the minority. Some of the products on the market are so bad that doctors sued the companies that sold them the dysfunctional EMRs. There are health centers that have gone out of business while trying to implement inefficient EMRs. Primary care physicians have been pushed out of practice by EMRs, contributing to our primary care shortage.

So how do I feel about health care reform?

The Affordable Care Act was health insurance reform, and I like its provisions ensuring coverage.

The HITECH Act was health record reporting reform, replacing functional paper systems with what sadly, too frequently, have been dysfunctional electronic medical records.  I have a very disfavorable opinion of the impact of incentivizing the adoption of any old EMR, without requiring that EMRs meet basic functionality requirements.

Together, the ACA and HITECH Act created a destructive environment for primary care doctors, where we take longer to see fewer patients when there are more patients to be seen. The mismatch of time and need are burning us out.

But let’s not blame our health care woes on Obamacare. Let’s blame it on HITECH, and seek to improve the functionality and efficiency of our electronic health records. We don’t need to appeal the ACA. We need to improve the HITECH Act, and ensure all EMRs on the market meet minimum standards out of the package, and that all systems can talk to each other to facilitate information exchange and better clinical care. Then we’ll get a healthier America, with happier primary care doctors. And I have a very favorable opinion of that prospect.

Kohar Jones is a family physician who blogs at Prevention Not Prescription.

Prev

The potential pitfalls of open access endoscopy

June 3, 2015 Kevin 0
…
Next

The problem of "less is more" in American health care

June 3, 2015 Kevin 7
…

Tagged as: Health IT

Post navigation

< Previous Post
The potential pitfalls of open access endoscopy
Next Post >
The problem of "less is more" in American health care

More by Kohar Jones, MD

  • a desk with keyboard and ipad with the kevinmd logo

    The gun violence epidemic is a traumatic injury epidemic

    Kohar Jones, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Blessed to be alive after a gunshot wound

    Kohar Jones, MD
  • a desk with keyboard and ipad with the kevinmd logo

    State legislatures should not enter the exam room

    Kohar Jones, MD

More in Tech

  • The pros and cons of using ChatGPT for your health care needs

    Liudmila Schafer, MD
  • A new era of collaboration between AI and health care professionals

    Harvey Castro, MD, MBA
  • What I think it means to be a medical student in the wake of AI

    Jackson J. McCue
  • The rise of generative AI in health care: Here’s what you need to know

    Anil Saldanha
  • Can AI solve the physician shortage crisis?

    Harry Severance, MD
  • Bridging the digital divide: How to bring trust back into the patient-physician relationship

    Arti Masturzo, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 59 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Use of EMR Directive Tied to Reduced Opioid Prescribing After Spine Surgery
  • Make the Diagnosis: This Bump on His Nose is a Tricky Diagnosis
  • CRT Regimen Boosts Complete Response Rate in Unresectable Vulvar Cancer
  • Fla. Doc Charged With Murder; McConnell Exits Rehab Facility; BPA on Store Receipts

Meeting Coverage

  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Use of EMR Directive Tied to Reduced Opioid Prescribing After Spine Surgery
  • CRT Regimen Boosts Complete Response Rate in Unresectable Vulvar Cancer
  • CDK4/6 Inhibition Active in Recurrent Low-Grade Serous Ovarian Cancer
  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A positive view of health reform, no thanks to the HITECH Act
59 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...