3 controversial questions about EHRs in 2014

There's been a lot of activity this past year concerning electronic health records, and many disagreements and points of view. Three topics in 2014 stand out as particularly troublesome and point to bigger issues that remain unresolved:

1. Is the EHR to blame in the misdiagnosis of the United States' first Ebola patient?

It's not often that the U.S. is thrust into a public health crisis, and a shame that the first Ebola patient, Thomas Eric Duncan, was initially misdiagnosed. But the back and forth over whether a flaw in Texas Health Resources' EHR system was the reason for the misdiagnosis--and whether EHR vendor Epic pressured the hospital to retract that assertion--was pretty ugly. As it turns out, both human error and EHR design problems may have been to blame for the misdiagnosis. But the episode highlights that EHRs need to be continually reviewed and retooled, and that vendors and providers need to be more proactive. It also should serve as a wakeup call to deal more quickly and forcefully with the problem of EHRs adversely affecting patient safety.

2. Do EHRs enable billing fraud, or don't they? 

The Office of Inspector General, the New York Times, and others have been warning about functionalities of EHRs such as cloning and default templates. But providers deny that they're committing billing fraud, and at least one study claims that there's no evidence that EHRs cause providers to submit higher claims. The real issue here may be not whether EHRs enable improper billing, but how to determine the line between "right coding" and upcoding. And why is software that alerts providers to "correct" billing deficiencies and that allows providers to alter electronic patient records without a trace even allowed on the market?

3. Is ONC in charge or not?

Yes, the Office of the National Coordinator for Health IT is the titular leader of all things EHR--its roadmap to interoperability, the Meaningful Use program, its strategic plan. But it's waffled a bit in 2014, opening the door for private enterprise to step in and fill a void. For instance, the American Medical Association, frustrated with ONC's lack of action, created its own framework to improve usability and a blue print to improve Meaningful Use. Then, a group of health IT giants--frustrated at the lack of interoperability and the slow government response to improve it--banded together to resolve the problem privately.  

There have always been those who have said that private enterprise and market forces should be dictating how EHRs are adopted. Does the industry need government guidance? Does it need more (or better guidance) than what it's getting? Or should there be no government involvement, at all?