A few days ago Dr. Jeffrey Singer, a surgeon in Arizona, had an op-ed in the Wall Street Journal regarding the fiasco of government-mandated electronic health records. Of particular interest is what can only be described as the reckless, haphazard manner in which the Obama administration went about foisting this debacle off on the medical community:
The program was inspired by the record-keeping models used by integrated health systems, especially those of the nonprofit consortium Kaiser Permanente and the Department of Veterans Affairs. The federal government mandated in the 2009 stimulus bill that all medical providers that accept Medicare adopt the records by 2015. Bureaucrats and politicians argued that EHRs would facilitate “evidence-based medicine,” thereby improving the quality of care for patients.
But for all the talk of “evidence-based medicine,” the federal government barely bothered to study electronic health records before nationalizing the program. The Department of Health and Human Services initiated a five-year pilot program in 2008 to encourage physicians in 12 cities and states to use electronic health records. One year later, the stimulus required EHRs nationwide. By moving forward without sufficient evidence, lawmakers ignored the possibility that what worked for Kaiser or the VA might not work as well for Dr. Jones.
Which is exactly what is happening today. Electronic health records are contributing to two major problems: lower quality of care and higher costs.
Later on, Dr. Singer describes how doctors feel about their new electronic overlords:
A 2014 survey by the industry group Medical Economics discovered that 67% of doctors are “dissatisfied with [EHR] functionality.” Three of four physicians said electronic health records “do not save them time,” according to Deloitte. Doctors reported spending—or more accurately, wasting—an average of 48 minutes each day dealing with this system.
That plays into the issue of higher costs. The Deloitte survey also found that three of four physicians think electronic health records “increase costs.”
I can personally attest to one way electronic health records are increasing costs. Over the last few years, I’ve probably been in a doctor’s office or hospital about 2 dozen times, ranging from fairly minor visits such as regular checkups for my son to emergency surgery for my wife’s broken wrist. In the past 2 years I’ve noticed a new trend – the doctor often has a new assistant, the ‘medical scribe.’ Since many doctors largely find electronic health records to be a waste of their time, they’ve farmed out the electronic recordkeeping duties to medical scribes, whose job it is to record the details of each patient-doctor interaction.
Medical scribes, of course, expect to be paid. So not only are doctors having to put big money into buying, installing, and maintaining their electronic health record systems, they have to hire someone to actually enter information into the system so they can concentrate on actually providing care.
Oh, about those costs:
A November report from the Agency for Healthcare Research and Quality found that the average five-physician primary-care practice would spend $162,000 to implement the system, followed by $85,000 in first-year maintenance costs. Like any business, physicians pass these costs along to their customers—patients.
There are a very few items the Obama administration has managed to get right when it comes to health care policy (a pathway for biosimilar approval at the FDA comes to mind). Electronic health records is not on that very short list.