Why EMR is a dirty word to most physicians

Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and the healthcare industry.

However, their origin and the ulterior motives currently driving their adoption is sowing the seeds of their failure. First, what is actually happening out there? The most recent CDC data would seem to be encouraging for EMR adoption, with EMR use (finally) passing 50%.

Too bad there is more to the story.

If you look at adoption rates for so called “fully functional EMRs,” the adoption rate remains in the low teens (full data for 2011 is not yet available). So why is there an almost 4-fold discrepancy between “any EMR” and “fully functional EMR”? If EMRs are so great, why does the government have to essentially “bribe” physicians to adopt them through incentives such as the meaningful use incentive program? Why is this so important to them that they didn’t even wait for the healthcare affordability act to implement this “incentive”? (They put it in the stimulus package after Obama had only been in office a few months.)

The 50% adoption rates seen in the first link reflect the presence of any type of an EMR-like technology. While it is a great headline for sure, the second link shows that this is an overly broad declaration. When we look at “fully functional systems,” meaning they are being used for a full work-flow solution, we get numbers in the low teens instead. (When you subtract out unique situations such as Kaiser, the VA, and a few large independent doctor networks, I suspect the actual number is much lower.)

One reason that incentives and threats of decreased payment are necessary for EMR adoption is that the industry and physicians have known for years that EMRs do not improve productivity and that it is highly questionable that EMRs lead to better patient outcomes. So why is all this taxpayer debt being accrued by throwing borrowed money at the healthcare industry to drive EMR adoption, if the end users are so disenchanted? As Jonathan Bush, the Founder-CEO of AthenaHealth (a major EMR supplier) famously said, “It’s healthcare information technology’s version of cash-for-clunkers,” and because it is actually all about control.

The goal of EMRs is to wrestle control of healthcare away from the doctor-patient relationship into the hands of third parties who can then implement their policies by simply removing a button or an option in the EMR. If you can’t select a particular treatment option, for all intents and purposes the option doesn’t exist or the red tape to choose it is so painful that there is little incentive to “fight the system.”

For patients, this means that they will only be able to consume the healthcare that they “qualify” for or be forced to find another way to obtain the care that they want and need. It is the second outcome that is the most intriguing, because as “shoppers,” patients will want to be informed and have choices as they take on more responsibility for the cost and quality of their own care. This approach works very well with Health Savings Accounts, which were conveniently de-emphasized in the healthcare reform effort. Like the lightning going to ground, this is the inevitable future for healthcare in this country (assuming the other alternative, an acceleration to a single-payer system does not occur first).

For physicians … well, it isn’t hard to figure out where this is all heading. EMRs are quickly becoming the instrument by which we are controlled and managed. As an example, many organizations are already starting to restrict diagnostic testing and therapies via EMR.

What’s next? Patient referrals? It will be the final step in subjugating physicians.

So why is genuine EMR adoption struggling so much? After all, one may argue that the accessibility of instant data that technology now enables is the greatest single advance in patient care so far this century. With so much money being thrown at the problem, one might expect a much greater adoption. Why hasn’t it played out in a much more positive way?

This comes back to the origin and ulterior motives of EMRs. First, EMRs have been largely a top down effort. Rather than working with physicians to design the technologies and drive adoption, the experience (and almost universally the perception) is that the technology has been thrust upon physicians by administrators. Compounding this is the unintended consequences of the meaningful use government incentives (or cash-for-clunkers program to use Jonathan Bush’s, more colorful language). Having left the guidelines vague and largely written by a small group of industry insiders, most products have become a Tower of Babel with atrocious user interfaces and user experiences that … well, I don’t blame my fellow physicians for not wanting to use them. In addition to being expensive, they are complex, inefficient, and do not make physicians or their staff more productive.

Widespread adoption of an EMR (or multiple compatible EMRs) that is intuitive and easy to use, that empowers the end user and patients, and that actually helps to make the healthcare system more efficient would be a good thing for doctors, patients, and the industry. However, unless we recognize what the ultimate goals are and better involve the people most critical to their effective use (physicians), I believe Jonathan’s prediction will be true and cash-for-clunkers applied to the healthcare sector will turn out about as successful as that other government program — TARP.