Editor's Corner: Why are EHRs being left in the evolution dust?

Marla Hirsch

Photo credit: Getty/pandpstock001

Would someone please explain why electronic health record development is still struggling?

Just look at some of this past week’s headlines.

First, the good news. After a rocky start, health information exchanges (HIEs) appear to be proving their worth. A new study in the Journal of the American Medical Informatics Association found that where clinicians in an emergency department asked for outside patient data from an HIE, they not only received the information faster than by fax or scan and were more likely to read it, but they also were able to capitalize on the information, reducing the length of the ED visit, the likelihood of imaging, the need for admission and even the cost of the treatment.  While less than 20 percent of the requests came via the HIE, had all outside information requests been fulfilled in that manner, researchers said the benefits would have increased five-fold. This really demonstrates that health IT and data exchange can improve patient health and reduce the costs of healthcare.

At the same time, the Carequality interoperability network has gone live. After all of the missteps and problems with interoperability--lack of standards, lack of regulatory guidance, etc--a group of EHR vendors, providers and others took it upon themselves to band together to connect their networks. They collaborated to create an interoperability framework and universal principles of trust, such as nondiscrimination against each other and transparency, and it worked. Providers in four states are exchanging information this way, and the initiative is set to expand further. Maybe we don’t need one national network, Congressional mandates and difficult to implement Meaningful Use rules to share information. And information blockers would soon be left out in the cold.

But EHRs--the cornerstones of HIE and interoperability--are still faltering. The systems still can’t adequately support patient safety research, despite their vast repositories of data, a recent study found. The researchers were unable to access some of the data, the data itself was too variable to make automated comparisons and IT personnel had competing priorities, most notably the Meaningful Use program requirements and EHR upgrades. While patient improvement research should be a priority, the researchers stated, it’s not.

Then there’s a scathing viewpoint article from doctors at Stanford University School of Medicine and the VA Palo Alto Health Care System in Menlo Park, California lamenting that while physicians are increasingly dependent on EHRs for diagnosis, monitoring and treatment in this ever more complex clinical environment, the software systems don’t support them. EHRs, they said, haven’t kept up with the technology, can’t integrate generalized information about patients at risk, don’t include social and behavioral factors and are overloaded with alerts and workload interruptions.

The authors added that EHRs were built for billing, not treatment, that doctors are “building resentment” against the “shackles” of EHRs and that “every additional click inflicts a nick on physicians’ morale.” Ouch.

I realize that evolution is often nonlinear. But here we are in 2016, and some aspects of EHRs seem stuck. Research issues, physician satisfaction and EHR design and usability concerns are not new problems. Why is interoperability seemingly improving, but not some of these fundamentals? What good is the exchange of data if it’s still unhelpful and hard to read

What is impeding EHR advancement?

It brings to mind the old adage: the more things change; the more things stay the same.

But that’s not necessarily a good thing. - Marla (@MarlaHirsch and @FierceHealthIT)

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