Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Disappointing outcomes despite a massive investment in EHRs

Mark Nunlist, MD and Betsy Nicoletti, MS
Tech
August 30, 2014
Share
Tweet
Share

The Health Information Technology for Economic and Clinical Health Act of 2009 committed to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care while promising dramatic improvements in quality, efficiency and safety.  Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment.

First, EHRs were designed to document the provision of health care as it was just delivered.  Most EHRs arose from a programming background emphasizing billing and claims processing; software’s priority was data capture of past transactions.  As a consequence, systems were not designed to provide sophisticated guidance to health care practitioners for “what comes next” in the care of a patient. With some important exceptions, the most important part of a patient’s medical care is the ongoing plan, and – unfortunately — EHRs still don’t effectively facilitate planning the future of a patient’s care.

Second, EHRs have been woefully inadequate when used for population health care management.

Software companies are only belatedly realizing their obligation to enable analysis of health care needs and disparities across entire populations of patients. Without a well-designed and implemented patient registry, an EHR cannot identify groups of patients with similar needs, thus impeding a practitioner’s ability to direct limited care resources to patients who would benefit from intensive management.

Third, engaging the patient — presumably an important party in improving health care through IT — has been an afterthought.  Adoption of electronic patient portals has been slow, in part because the design and user interface of portals lack polish, and in part because portals fail to provide patients with actionable information to guide personal health care management.

One of EHRs largest failures is their inability to communicate with one another, a prerequisite to attaining the promised goals. The health care IT industry has been derelict in its responsibility to comply with standards of interoperability, and no funding mechanism has been established to develop the requisite interfaces among software systems in current use.  A patient who transfers from one physician to the next will most likely need to bring a print out of his or her “electronic” health record to be scanned into the “electronic” record in their new practice.  Diagnostic results and hospital records in one system are frequently unavailable within another electronic platform, requiring physicians to access multiple systems for these records, each system requiring a different username and password. If members of the general public were aware that “computers aren’t talking to one another” as patients navigated the multiple providers involved in their care, they would be shocked at the lack of planning and foresight.

Last, we have succumbed to an all-consuming demand for privacy of health care information without considering the implications.  Personal health care information provided to one’s practitioner during a visit is available only to that practitioner, ignoring the potential that the patient may present to another practitioner with a related problem — possibly in another community or even state. The critical allergy or important surgical history reported at one facility is not available when that patient — possibly incapable of providing the relevant history — requires urgent care in another locale.  We should reasonably expect that all relevant information is immediately available to any healthcare practitioner who needs it to provide safe and effective care, regardless of facility or location, and yet we have tolerated the development of laws and IT systems that make it impossible.  This is a dangerous outcome of our reflexive demand for total privacy, especially when the vast majority of patients correctly assume that healthcare information will be responsibly accessed and used.

Until EHRs guide practitioners in the future provision of care rather than simply serve to document care already delivered, facilitate stratification of patient populations by disparity or need, successfully engage patients in their own care, and “talk” to other systems involved in a patient’s care, we will fail to recognize significant benefits from our massive IT investment.  And without a more sophisticated concept of health care privacy, we will continue to hamstring efforts to use information technology to its fullest advantage.

Mark Nunlist is a family physician.  Betsy Nicoletti is president, Medical Practice Consulting and author of Auditing Physician Services. She blogs at Nicoletti Notes.

Prev

Deciphering hospital bills is not for the faint of heart

August 30, 2014 Kevin 9
…
Next

How many servings of fruits and vegetables should we eat a day?

August 30, 2014 Kevin 2
…

Tagged as: Health IT

Post navigation

< Previous Post
Deciphering hospital bills is not for the faint of heart
Next Post >
How many servings of fruits and vegetables should we eat a day?

ADVERTISEMENT

More in Tech

  • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

    Gabe Jones, MBA
  • Generative AI 2025: a 20-minute cheat sheet for busy clinicians

    Harvey Castro, MD, MBA
  • Why public health must be included in AI development

    Laura E. Scudiere, RN, MPH
  • Here’s what providers really need in a modern EHR

    Laura Kohlhagen, MD, MBA
  • AI and humanity in health care: Preserving what makes us human

    Harvey Castro, MD, MBA
  • AI is not a threat to radiologists. It’s a distraction from what truly matters in medicine.

    Fardad Behzadi, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Addressing U.S. vaccine inequities in vulnerable communities [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Addressing U.S. vaccine inequities in vulnerable communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 31 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Addressing U.S. vaccine inequities in vulnerable communities [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Addressing U.S. vaccine inequities in vulnerable communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Disappointing outcomes despite a massive investment in EHRs
31 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...