In a world where information technology is inextricably entwined in how we live (when was the last time you spent more than 24 hours without online access?), it’s often baffling to see how slowly health care has embraced all things digital.
To be sure, most hospitals and medical groups are making progress. A majority of physicians now have the ability to e-prescribe, and it would be hard to find a health care organization that doesn’t use or store at least some patient information electronically. On the whole, however, there’s a long road ahead for many organizations to reach the nirvana of a fully integrated electronic health record that incorporates both clinical and billing information, allows information to be exchanged between providers and organizations, and makes the fullest use of technology to enhance care.
It prompts the question: Why?
Because adoption of an electronic health record system is neither simple, straightforward nor cheap, that’s why. It demands a major commitment from health care organizations – a commitment, moreover, that tends to be mostly invisible to patients and the public and may not offer an immediate payback.
Going live with the new system, which replaced six disparate health information systems across the hospital, involved a $4 million investment, a full year of planning and countless hours of training before flipping the switch on Feb. 1, 2012. One year later, Rice still has lots of work ahead to optimize the system and reach additional milestones that will qualify the hospital for the next stage in federal meaningful use criteria.
The hospital is starting to see some of the benefits – no more chasing down of paper charts, for one. But it’s not hard to realize why many health care organizations would hesitate to dive into EHR adoption when they know how time-consuming and resource-intensive it’s going to be.
Indeed, clinicians and health care leaders are often ambivalent over whether the EHR is an enhancement to patient care or an invention of Satan.
Consider the responses to a recent blog entry by Dr. Robert Wachter, one of the leading voices in the U.S. for patient safety, about the federal HITECH program to promote the use of information technology in health care.
Doctors used words such as “tedious” and “akin to torture” to describe their experiences with the EHR.
“My role anymore is about 50% practicing medicine and the rest being a data entry clerk,” one commenter complained. “It has overall decreased my efficiency rather than increased it. I really like some aspects of it such as drug interaction warnings and clinical reminders. There’s a lot I don’t like.”
From someone else: “Most of American medicine is not done in large clinics or hospitals with their own in-house IT staff and the burden on the rest of us has been near intolerable.”
Earlier this year the American Medical Association sounded an alarm over the federal push toward higher and higher levels of meaningful use, warning that it may be too much, too fast for many providers, especially in view of issues with software design and usability that haven’t been fully resolved yet.
There’s emerging evidence that although some aspects of the EHR are safer, such as replacing handwritten physician orders with computerized physician order entry, the technology also has introduced new potential for other types of errors. Although patient portals are part of the meaningful use requirements and are meant to encourage more engagement by patients, they tend to contain limited information, and organizations are beginning to find that the mere presence of an online portal does not mean patients will actually use it.
So what’s the good side?
A growing body of research confirms the benefits of information technology in making health care safer and creating new opportunities for mining health data to improve care. A survey last year of physicians found that the majority had few complaints about using an EHR and most also felt it helped make their practice more efficient.
Here’s what Dr. Wachter has to say to the critics:
Let’s pause to ask a few questions: Does anyone honestly believe that computerizing American healthcare is wrongheaded? Or that the correct strategy was to continue toe-tapping, waiting for “the market” to promote IT adoption when, in 2009, only 16 percent of US hospitals and doctors’ offices had functioning clinical IT systems? Or that they would like to be a patient, or a clinician, in a paper-and-pencil hospital?
I didn’t think so.
Love it or hate it, the electronic health record is clearly on its way to becoming a permanent part of the health care landscape. The challenge, it would seem, lies in constructively addressing the vulnerabilities of the EHR, supporting organizations through the transition, using feedback from clinicians to make EHR systems better, and trying to eliminate some of the pain inherent in the process so the electronic health record can begin to deliver all that its supporters have promised.