EHRs, A Good Idea Turned into Madness

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As part of the approximate $800 billion 2009 federal stimulus package, the Health Information Technology for Economic and Clinical Health Law (HITECH Act) devoted about $25 billion to supposedly aid physicians and hospitals to convert from either their present electronic medical record (EHR) or paper to programs “certified” by the Center for Medicare/Medicaid Services (CMS) (Ref.1). Many hospitals and doctor practices had already spent large sums developing their own EHRs which had to be scrapped at far greater expense. Proponents of the HITECH Act touted a 2005 Rand study, sponsored by the group of companies that sell EHRs (vendors), that total electronic transformation would save the government $81 billion/year. This study was retracted by the Rand corporation in 2013, but NOT before it led to a huge increase in EHR vendor business and unwarranted excitement by the political class. The 2013 study revealed NO savings (Ref.2,3). The CMS certification process created a monopolistic situation ensuring huge profits (up to a billion dollars) for a few companies along with stifling competition (Ref.4). Political contributions by the “certified” EHR vendors, over the years, total multiple millions (Ref.5). Strengthening the enticement for adoption was that there would be a yearly deduction in reimbursement up to 5% for not using a “certified” EHR starting in 2015. This superimposed on below cost Medicare/Medicaid payments. Adding to the overwhelming administrative physician burden was a panoply of bureaucratic jargon, under the guise of paying for value, VBPM, PQRS, MU (meaningful use) and MIPS created by the 2015 Medicare and Chip Reauthorization Act (Ref.6). To the advantage of the vendors, more variables require more complex EHR programs increasing costs and profits while expanding the burden on physicians.
    What should have been the goal of this effort? To enhance the patient-physician personalized therapeutic relationship by creating more time with the patient and easier communication. One would think that before finalizing requirements for payment the federal government would ask for physician organizations and patients’ input, then test various models to work towards the best possible prototype; none of this occurred. Instead, input was from Congress, bureaucrats, CMS and the EHR vendors. Although federal websites suggest many advantages, tragically the reality is that present day EHRs have had severe negative effects on patient care, physician well-being (burnout) and financial distress (Ref.7). The clumsiness and time-consuming nature of these EHRs is having a devastating effect on physician training with only a small fraction of time spent with patients as compared with the computer (Ref.8). This bodes poorly for our medical care in future decades. 
    The approved EHRs are extraordinarily expensive causing hospitals to spend hundreds of millions of dollars on initial and maintenance costs reducing investment in patient care. The cost and excessive time required by these “certified” programs have forced physicians to abandon private practice and become hospital or Hedge fund employees. This forced the closure of hundreds of thousands of small businesses, private practices devoted to serving the needs of patients. 
    Another fatality is university hospitals as primarily educational and research organizations. Because of the financial pressures of inadequate Medicare/Medicaid reimbursements and the colossal costs of “certified” EHRs they now pursue patient care dollars in direct competition to non-academic facilities. This is detrimental to the advancement of medical science.
    A years long well executed plan by the EHR vendors which sponsored a flawed report by a think tank, copious contributions to politicians, encouraged “certification” and complexity, all increased their economic position which devastated the practice of medicine. Unfortunately, our politicians swallowed the bait.

  1. What is the HITECH Act, HIPPA Journal, available at: https://www.hipaajournal.com/what-is-the-hitech-act/ (accessed October 21, 2021)
  2. Reed Abelson and Julie Creswell, In Second Look, Few Savings from Digital Health Records, New York Times, January 10, 2013, available at:   https://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html (accessed October 20, 2021
  3. Art Kellerman and Paul O’Neill, More Changes in Health Care Needed to Fulfill Promise of Health Information Technology, Rand Corporation, January 7, 2013, available at: https://www.rand.org/news/press/2013/01/07.html (accessed October 21, 2021)
  4. CMS.gov., Certified EHR Technology, Centers for Medicare & Medicaid Services, October 9, 2021, available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification (accessed October 19, 2021)
  5. Julie Spitzer, Health IT gets political: Campaign Contributions from Epic, Cerner, athenahealth and Allscripts, Becker’s, July 16, 2018, available at: https://www.beckershospitalreview.com/healthcare-information-technology/health-it-gets-political-campaign-contributions-from-epic-cerner-athenahealth-and-allscripts.html (accessed October 19, 2021)
  6. Meaningful Use, Meaningful Use and the Shift to the Merit-based Incentive Payment System, HealthIT.gov, October 22, 2019, available at: https://www.healthit.gov/topic/meaningful-use-and-macra/meaningful-use (accessed October 21, 2021)
  7. Roger Collier, Electronic health records contributing to physician burnout, CMAJ 189, November 13, 2017, available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687935/ (accessed October 18, 2021)
  8. Lauren Block, Doctors-in-Training Spend Very Little Time At Patient Bedside, Study Finds, Johns Hopkins Medicine, April 23, 2013, available at: https://www.hopkinsmedicine.org/NEWS/MEDIA/RELEASES/DOCTORS_IN_TRAINING_SPEND_VERY_LITTLE_TIME_AT_PATIENT_BEDSIDE_STUDY_FINDS (accessed October 17, 2021)

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