David Blumenthal, former National Coordinator for Health IT and current president of the Commonwealth Fund, published a very insightful and thought provoking blog post last week about the fact that electronic health records are now the industry's "understandable but not wholly justifiable" scapegoat for many of the problems in healthcare. Among other things, he pointed to the human tendency to want to cast blame rather than take responsibility for mistakes, the fact that EHRs are "imperfect" systems, and that they're at the forefront of clinicians' minds, literally "in their faces" all day long.
He also stated, rightly so, that much of the dissatisfaction that stakeholders have with their EHRs is not caused by EHRs per se, but rather by the bigger problems in the healthcare industry--such as high costs, disparities in care and quality issues--all of which have led to "disruptive" reforms.
But there is one item in his article with which I don't agree. He wondered why healthcare professionals have not embraced health IT at the same time that cloud computing, smartphones and other technology are "revolutionizing" the economy both professionally and personally.
"That one of our most information-intensive industries--accounting for 18 percent of gross domestic product--has so steadfastly resisted the modernization of its information management practices is puzzling to say the least," he said.
I don't find it puzzling. I find it pretty obvious. Here's why:
- Healthcare providers, arguably some of the most independent individuals used to making their own decisions, are being pressured not only to adopt EHRs, but to adopt only certain kinds of EHRs, and use them in a certain way, even when the system isn't as useful as it could and should be. If they don't use their systems in a "Meaningful" way; they'll lose reimbursement.
- EHR systems are expensive. That's money that could have been invested elsewhere.
- The jury is still out regarding whether providers are getting their money's worth. Studies have shown that providers may not be getting a good return on their investment.
- They don't always work well. Even Blumenthal acknowledged that the systems are deficient. While they can be beneficial, they're cumbersome, disrupt workflow, create new patient safety concerns and impede patient communication.
The real reason that clinicians are dissatisfied with their EHRs and have resisted their implementation is that the systems aren't yet in sync with the needs of the industry. There's a disconnect in the industry between EHRs and the Meaningful Use program and the current way the industry operates.
Blumenthal assured readers that EHRs will improve, and will be more accepted as more youthful clinicians take over the industry. He's stated this before. He also pointed out that "there is no going back" to paper.
It's a process, of course. I understand that EHRs are being improved as they mature, and that some patience on the part of providers is in order. Rome wasn't built in a day.
But that doesn't help those who are struggling now. How many years of struggle does that translate to? And that's with no guarantee that EHRs will ever be "perfect."