When The Digital Revolution Took a Wrong Turnby admin on 04/27/2019 2:27 AM
The U.S. government claimed that turning medical charts into electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, we became aware that the digital revolution had taken a very bad turn.
Which brings us to the strange, sad, and aggravating story that unfolds below. It is not about one lawsuit or a piece of sloppy technology. Rather, it’s about a trouble-prone industry that intersects, in the most personal way, with every one of our lives. It’s about a $3.7 trillion health care system idling at the crossroads of progress. And it’s about a slew of unintended consequences — the surprising casualties of a big idea whose time had seemingly come.
The Virtual Magic Bullet
Electronic health records (EHR) were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country — essential when life-and-death decisions are being made in the ER.
But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment. Kaiser Health News (KHN) and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it. . .
Instead of reducing costs, many say, EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in “upcoding” or bill inflation (though some say the systems also make such fraud easier to catch).
More gravely still, a months-long joint investigation by KHN and Fortune has found that instead of streamlining medicine, the government’s EHR initiative has created a host of largely unacknowledged patient safety risks. Our investigation found that alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories. . .
David Blumenthal, who, as Obama’s national coordinator for health information technology, was one of the architects of the EHR initiative, acknowledged to KHN and Fortune that electronic health records “have not fulfilled their potential. I think few would argue they have.”
The former president has likewise singled out the effort as one of his most disappointing, bemoaning in a January 2017 interview with Vox “the fact that there are still just mountains of paperwork … and the doctors still have to input stuff, and the nurses are spending all their time on all this administrative work. . .
Doctor burnout: Many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients. . . Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual “gag clauses” that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families. . .
Read more . . .
Kaiser Health News and Fortune Magazine collaborated on this joint investigation for three months. Fred Schulte is a senior correspondent for KHN. Erika Fry is an investigative reporter for Fortune.
Only certain images can be republished by partners. Email KHNweb@kff.org for more information.
This story can be republished for free (details).Editor’s Note: We can vouch that important records were readily available from doctor to doctors in most of our professional lifetimes. After the digital revolution along with the Health Insurance Portability and Accountability Act (HIPAA) this was impossible even in emergencies. Records were withheld while patients could be dying on the ER table until a signed release was delivered.
Well-Meaning Regulations Often Worsen the
Quality Of Care (QOC)
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