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Sunday, April 24, 2016

If meaningful use is a great idea, why isn’t it employed more widely?

A decade ago, electronic health records were aggressively promoted for a number of reasons. Proponents claimed that they would facilitate the sharing of health information, reduce error rates in health care, increase health care efficiency, and lower costs. Enthusiasts included the technology companies, consultants, and IT specialists who stood to reap substantial financial rewards from a system-wide switch to electronic records.

Even some health professionals shared in the enthusiasm.  Compared to the three-ring-binders that once held the medical records of many hospitalized patients, electronic records would reduce errors attributable to poor penmanship, improve the speed with which health professionals could access information, and serve as searchable information repositories, enabling new breakthroughs through the mining of “big data.”

To promote the transition to electronic records, the federal government launched what it called its meaningful use program, a system of financial rewards and penalties intended to ensure that patients would benefit.  Naturally, this raised an important question: If digitizing health records was such a good idea, why did the federal government need to impose penalties for health professionals who failed to adopt them?  Perhaps electronic health records were not so self-evidently beneficial as proponents suggested.

Despite the availability of $35 billion of federal funding to incentivize the adoption of this new health information technology, results have been disappointing.  For one thing, physicians, nurses, and other health professionals who rely on such systems on a daily basis reported steadily decreasing levels of satisfaction with them.  The move to electronic records has not only failed to enhance patient care but in many cases actually interfered with it.

For example, the requirement to populate the health care record with data, often motivated less by the needs of the patient than payment protocols, often draws the health professional’s attention away from patients.  Instead of increasing health professionals’ effectiveness and efficiency, too often such systems end up functioning as a distraction, keeping physicians’ and nurses’ eyes glued to a computer screen instead of the people they are caring for.

Far from increasing efficiency, many physicians find that electronic health records have slowed them down.  Faced with such tradeoffs, some simply give in, glumly allowing their gaze to shift from patients to computers.  Others extra spend extra hours on evenings and weekends attempting to tick off all the boxes.  Still others have chosen to hire “scribes,” whose job is to fill out the forms; a paradoxical situation in which enhanced efficiency has led to the hiring of additional personnel.

A related barrier to adoption was always the substantial cost of implementation.  In the short term, the productivity of health professionals suffered, as they struggled to learn complicated new systems.  Unfortunately, many of these costs turned out not to be temporary, inflicting ongoing losses in productivity and quality of care.  The same could be said for the professional satisfaction of many health professionals, who felt as though they had been transformed into data entry specialists.

As a result, the principal point of contact between health professionals and the hospitals and health systems they work for has shifted further and further away from the needs of patients.  We are producing more health care data than ever before, but much of this information is both irrelevant and difficult to access.  Really relevant clinical knowledge has been watered down by data that exist purely for purposes of documentation, regulation, and payment.

One disastrous misconception underlying electronic health record systems is the notion that documenting health care somehow improves it.  In practice, this has led physicians and nurses to spend more and more time documenting instead of doing, without good evidence that it is helping patients.  Just because an action is documented does not make it either real or beneficial.  In many cases, the burdens of documentation have turned out to outweigh its benefits.


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