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The EHR Debate Reaches a Boiling Point

March 20, 2013
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There’s an internal battle going on in the healthcare world, and over the past few months it has begun to boil to the surface.

We’ve had surveys on how EHR satisfaction is dwindling and why many providers may switch vendors. We’ve seen an extremely controversial article from The New York Times asserting that the Health Information Technology for Economic and Clinical Health (HITECH) Act has been a boondoggle for electronic health record (EHR) vendors, as well as the emergence of a trend on Twitter called #EHRBacklash.

It doesn’t just end there. Researchers on the RAND Corporation recently reversed course on their EHR cost-savings optimism. And we’ve seen lawsuits against EHR vendors and there are reports about how EHR implementation leads to revenue loss in some cases.  It’s the EHR advocates vs. the luddites. This is almost as good as the alliance vs. the Borg.

But in all seriousness, there is clearly a large percentage of physicians (as well as others within the industry) frustrated, not only with current EHR products, which they have critiqued as unusable, burdensome, and ineffective, but the required meaningful use measures as well. Just take a look at the comments on that New York Times piece. Whether or not you feel the article was accurate or fair, it obviously spoke to the irritation of a decent amount of doctors.

When it comes to healthcare legislation, cynicism and resistance have always come with the territory.  Someone at the Healthcare Information and Management Systems Society (HIMSS) conference, either President Bill Clinton or his former advisor James Carville, rightly pointed out that there was a lot of cynicism around Medicare back in the 1960s. And, let’s face it, the Affordable Care Act and HITECH are big deals, policy-wise.

But the outrage seems to be more than your typical, anti-government trust issues. The meaningful use train is rolling along, and many are wondering if the actual EHR systems themselves are paying the price. That is essentially the core theme of various mainstream media pieces, like the one from the NYT or this one last September from The Wall Street Journal. It’s what caused the American Medical Association to send the government this letter. And it’s the basis of the findings from the aforementioned surveys, studies, and reports.

When the Office for the National Coordinator of Health IT (ONC) and Centers for Medicare & Medicaid announced that the preliminary rule of Stage 3 of meaningful use was going to be delayed until 2014, so they could reflect back on Stages 1 and 2, most HCI visitors agreed with the decision in a poll. 

In some cases, it’s not said, but rather implied. In other cases, it’s said out loud. Take a look at website for the folks behind the #EHRBacklash trend on Twitter. Steven E. Waldren, M.D., former director of the Center for Health Information Technology of the American Academy of Family Physicians (AAFP), and Bob Brown , vice president of Professional Services for Mosaica Partners, launched the Cure Project this month because of the “deplorable” state of health IT systems.

“Many are just plain horrible.  Ineffective, standalone, kludgy, workflow-oblivious systems, and near-impenetrable organizational and enterprise information silos are terms often used to describe the situations we see around us.”

Those are some strong words. On the flip side, the government hasn’t taken lightly to these kinds of charges, and neither have health IT vendors. The National Coordinator of Health for Health IT, Farzad Mostashari, M.D., and others at the ONC always promote examples in the industry of organizations that have successfully implemented health IT systems, and used them to lower costs and better care. Obviously, vendors are doing the same thing for their own specific systems.




Thanks for your Boiling Point article. I just wrote a piece on Usability here - , the gist of which is that most organizations have found clever ways to make EHRs usable. There were certainly dozens of presentations from real-world provider organizations that demonstrated that at HIMSS this month. Ditto for prior years.

Prior to HITECH, there was little reason to have confidence that clinical summaries would become a standard. It's probably a sign of progress that usability is getting the spotlight, as we raise the bar on fundamental communications. I think you said that very clearly. Thank you.

Thanks for your comment Joe. I enjoyed your blog and it's interesting how some providers are working around the problem of EHR usability. Good to see there is progress in that area. There seems to be a disconnect between the people who want to try and make this work, and those who are getting pulled into this kicking and screaming.

In a recent series of posts, I've been blogging about ways to make EHRs much better through implementation of disruptive innovation. The first post starts at this link.

Steve Beller, PhD