It has been a decade so people may have forgotten all the hype when the federal government passed various laws trying to force wider use of electronic medical records. The theory was they would improve quality and lower administrative and medical costs. Almost all providers now do use an EMR, but as usual, it is not even clear that the benefits outweigh the costs. A Fortune article reveals results of an “investigation”, which only tells us what we already knew from lots of research on the topic. (Fortune Article) The authors talked to a large number of participants in the health system and health information technology for the story. The article starts out with a rather sensationalistic, although sad, story about a patient death allegedly caused by a buggy EHR system. It is true that, like any software, EHRs often don’t work as described. But the deeper problems have been caused by what they do to provider workflows and to administrative costs. I am not sure how much EHRs have contributed to worse patient safety, I actually suspect that on balance they have improved it as much as harmed it. The authors appropriately identify other issues–forcing doctors and other clinicians to focus on a computer instead of the patient, adding administrative costs, facilitating “upcoding” and other abusive billing practices, difficulty in disparate systems communicating and sharing data, alert fatigue, data overload, and on and on and on. The most ironic is the frequency with which providers develop manual, often paper-based work-arounds to EHR dysfunction. And of course there is the whole scribe industry which has developed to help ease doctors frustrations with information technology.
Only in the largest health systems, where there are ample resources to customize and train, has there been a perception of benefit outweighing hassles and costs. Maybe future generations of software will be better and will be more consistent with typical provider workflows. The authors describe the mandating of EHRs as a “missed opportunity”, but the reality is that even at the time the law was proposed there were plenty of people who warned about the overpromises and the costs and issues that would ensue. It is really just another case of uninformed policymakers with no real world experience thinking they can design a better system, a better world, for all of the rest of us. The best thing they could do is leave us, and the health system, alone.