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ELECTRONIC MEDICAL RECORDS RECONSIDERED

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At Docs 4 Patient Care Foundation we believe in the potential of electronic medical records (EMR) and other forms of health information technology (HIT) to improve quality of health care and reduce costs by improving efficiency and reducing errors. But if these powerful tools are designed poorly or used incorrectly, they have equal potential to do harm to patients. We are very concerned that the HITECH incentive program, passed as part of the American Recovery and Reinvestment Act, is forcing the adoption of HIT too quickly, before these products are ready for widespread use and before health care providers understand them adequately.

To most practicing physicians the benefits of EMR remain elusive. Why do so many doctors question the wisdom of EMR when its benefits seem so clear to the government and to the health information technology (HIT) industry?

1. There is little evidence to support the safety and efficacy of EMR. Although it seems intuitive that “computerizing” health care will improve quality and efficiency, this has not yet been proven. There is in fact some evidence to suggest that EMR, as it is currently designed and used, may reduce quality of care and raise costs. A 2009 report by the National Research Council, written by two HIT pioneers who visited several centers of HIT excellence, concluded that current implementations of HIT, “will not be sufficient to achieve medical

Docs4PatientCare Foundation · A 501(C)3 Non-Profit Organization www.d4pcfoundation.org · 888-788-5515
1210 North Maple Road · Ann Arbor, MI 48103

leaders’ vision of health care in the 21st century and may even set back the cause.” A more recent study published in 2012 showed an increase in imaging test utilization by providers who had electronic access to imaging test results. The same study showed that the use of an EMR did not improve (lower) the rate of test utilization.

  1. There is no business model that makes EMR profitable, or even revenue- neutral. Like any business a medical practice must survive financially. EMR is a huge expense. The total cost of an EMR over the first 5 years far exceeds the $44,000 per provider incentive offered by HITECH. A practice cannot purchase and maintain an EMR without a strategy to recover the investment. This is one of the reasons so many practices have abandoned EMRs.
  2. There are no established EMR implementation strategies for medical practices.A mature EMR has many components that must work together. A practice cannot implement every component at once. The right parts must be implemented in the right order. New components must be added without reducing patient volume and without any errors in patient care. It is akin to replacing an aircraft’s engines while it is still flying. How does a practice decide what to purchase first and what to upgrade next? Right now it is by trial and error.
  3. Data capture technology is badly lacking. The most detrimental effect of EMR is the burden of data entry. This burden has changed the culture of medicine where EMR is used. Clinicians have been reduced to data entry clerks. The emphasis has changed from face time with patients to face time with computers. That is terrible for patient care. No currently available technology allows efficient, timely data capture.Docs4PatientCare Foundation · A 501(C)3 Non-Profit Organization www.d4pcfoundation.org · 888-788-5515
    1210 North Maple Road · Ann Arbor, MI 48103

5. Usability of today’s health IT products is poor. The Department of Commerce’s National Institute of Standards and Technology reported in 2011 that shortcomings in the usability of current EHR systems impair the adoption and meaningful use of these systems, and opined that the poor usability of current EHR applications has a substantial negative effect on clinical efficiency and data quality.

Health information technology will change the landscape of medicine more than any drug, imaging modality, operation or minimally invasive endoscope. It will profoundly affect the care of every patient. No other past or current medical advancement can make that claim. HIT has the potential to make medicine safer, more efficient and less costly – but only if designed, implemented and maintained with care. It is equally capable of doing the opposite of all these things if done poorly.

We do not yet understand how to use EMR well. We therefore also do not understand what expertise is required of those who design and implement this technology. The recent abandonment of UK’s National Health Service EMR system demonstrates that no EMR is “too big to fail.” We must learn from this example. To avoid a similar fate in the U.S. we must develop an adequate fund of HIT knowledge before pushing its widespread use.

Any new technology, including health information technology, produces unexpected adverse consequences. For such events the HITECH incentives create a frightening multiplier in HIT. What if the government had required all overweight patients to use Fen-Phen before its cardiac side effects were discovered? What if all patients with arthritic hips had been required to receive cobalt-containing implants? In an environment where every innovation is rightfully scrutinized before it is placed into

Docs4PatientCare Foundation · A 501(C)3 Non-Profit Organization www.d4pcfoundation.org · 888-788-5515
1210 North Maple Road · Ann Arbor, MI 48103

widespread use, why do so many accept the unproven claims of HIT as unchallenged fact? The HITECH alliance between government and the HIT industry has replaced critical analysis with blind enthusiasm and has replaced innovation with mindless regulatory compliance. The HITECH incentives have sucked all the oxygen out of the room where original thought once took place.

It is time to get our priorities straight. Quality patient care comes before information technology, and until the latter is proven safe, effective and practical, the former must prevail.

For more information on EMR and other HIT issues call:

Michael Koriwchak, MD
Vice President
Docs 4 Patient Care Foundation 404-276-2461 mkoriwchak@entofga.com

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