For the past several years, scores of physicians and health systems have bemoaned the mandate of EHRs, taking issue not necessarily with the concept of EHRs as a whole but with the additional workloads that often came with them and the clunkiness of operating them.
It can often detract from actual face time with a patient and places further burden on many already burdened healthcare clinicians, the thinking goes.
So when Texas Health Presbyterian in Dallas initially pinned its missed diagnosis of Ebola on the EHR, it wasn’t all that surprising. But it’s perhaps misplaced.
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Dr. David Blumenthal, in a piece for the Commonwealth Fund, takes on the issue. It turned out the EHR was not, in fact, to blame at the Dallas hospital, but the rush to blame is indicative of other issues in healthcare, Blumenthal notes – chiefly the perceived loss of autonomy.
“Texas Health Presbyterian’s reflex to blame its EHR was revealing at many levels. First, it showed that, in the face of error, health care providers often look for scapegoats. This is a long, inglorious pattern in human behavior, to which health care officials are evidently not immune.
The hospital’s decision to finger its EHR also showed how tempting a target EHRs have become as providers try to deal with a multitude of challenges. Mostly, these arise not from EHRs but from the deep crises facing our health care system: high costs, deficiencies in quality, and profound disparities in the care available to people of different income levels, races, and ethnicities.”
Such issues have led to reforms in healthcare that “are profoundly disruptive to providers,” Blumenthal notes. The massive sea change occurring within healthcare threaten hospital bottom lines and “the cherished autonomy of physicians.”
Driving that disruption is a host of heavyweight legislation, not the least of which includes the ACA, Meaningful Use and the HITECH Act of 2009. Add to that the rapid advancements of mobile and cloud-based technologies that have dramatically altered society as a whole.
A quick history reminder – in 2009, 83 percent of doctors and 90 percent of hospitals were still using paper records for patient information. Yet we all know that the healthcare system, largely speaking, has somehow been less than enthusiastic to embrace the movement.
Despite the resistance, now 81 percent of physicians and 97 percent of hospitals have moved to EHRs. But EHRs still make for a great scapegoat, for several reasons, Blumenthal says.
For starters, the EHR can no longer be avoided and is literally in the face of the provider – often hundreds of times a day – making it seem like the other, arguably bigger changes in healthcare are far more distant. Secondly, the current EHR systems are “imperfect.”
“Providers are absolutely right to be unhappy about these aspects of the electronic health information revolution—and to demand improvements from vendors. Those improvements will come, but will take time.”
Third, and perhaps more ethereal than the first two reason, is that discontent with EHRs “ reflects profound underlying dysfunctions in our health care system.” This is indicated by the fact that, while many doctors remain frustrated with their EHR systems, they see clinical value for the patient.
“That physicians see the value but still have negative feelings about EHRs speaks to an asymmetry of benefits and costs. Patients gain, but clinicians and hospitals incur costs—in dollars, time, and disrupted routines—that current payment systems (federal incentives included) only partly cover.”
Underscoring the issue is the old mindset of fee-for-service – rewarding volume over value that EHRs can create. And lest any physician think otherwise, EHRs are here to stay, Blumenthal says. But the frustrations are real and by no means suggest doctors are all Luddites.
“There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. …. In the meantime, blaming EHRs for whatever ails American health care is an understandable, if not wholly justifiable, reaction to the dramatic changes with which providers are grappling.”
