Electronic health records were once touted as a turning point in U.S. health care, expected to revolutionize recordkeeping on patient histories and reduce the potential for medical errors. I hope that someday they will. But as the Affordable Care Act launches and, presumably, more Americans seek treatment, there is no standard system nationwide, and entry errors and inconsistencies are becoming common.
Ironically, the most significant benefit of the expensive, multiyear effort to implement electronic health records may be legible medical notes.
Medical billing is a chronic war between those wanting to get paid (physicians, hospitals) and those not wanting to pay (insurance companies, government). While billing has long been computerized, the shift to electronic records among clinical practices is relatively recent. The 2009 stimulus legislation made billions in federal funds available for the transition to electronic health records, with more earmarked for the future. Hundreds of electronic systems now exist.
To greatly simplify, the dog-and-pony show goes something like this: A company hypes its system, emphasizing its compatibility with billing procedures. Administrators buy the systems, generally without input from the doctors, nurses and others who enter the data.
A June editorial in the Annals of Internal Medicine rightly called the universe of electronic health record systems a “Tower of Babel,” noting that a 2012 study found that only about 10 percent of U.S. physicians reported “meaningful use” of the systems.
These systems tend to be fantastically complex. One doesn’t have to be intimately familiar with, say, Hertz or Enterprise to rent a car online. But many electronic health record systems have pull-down screens listing each of the 68,000 possible diagnosis codes in the World Health Organization’s International Classification of Diseases and 87,000 possible procedure codes.
Or consider what happens when I write a prescription: Every potential drug interaction or side effect listed generates a warning prompt. Inevitably, recognizing that the warnings are generally inapplicable and take time to sort out, clinicians start to bypass the alerts. Sooner or later, ignoring one will lead to serious complications.
Compounding these issues is the fact that hospitals, clinics and offices have different systems. When these systems get overloaded or go down, even more work is generated, sparking delays in care.