When the Obama administration began pushing the use of electronic health records (EHR), they were touted as a “savior” for medicine. But instead of saving money for patients, doctors and hospitals, EHRs have increased costs and yielded record-breaking profits for EHR vendors, such as EPIC and Cerner. Even worse, they have compromised care and interfered in medical decision-making.
EHRs, sometimes referred to as EMRs or electronic medical records, have complicated and change the medical practice. This health information technology literally changes the way patient information is recorded, viewed and considered during diagnosis and treatment. David Do, MD, writes:
We all know EMRs are painful to use. These systems are reminiscent of software from the 90s, with inconsistent menus, obscure placement of data, and overwhelming numbers of buttons. It’s not uncommon to traverse ten menus to order a routine laboratory test, or to miss a critical note or lab value hidden in an obscure screen.
Pre-EHR, the diagnostic process would typically include “looking at six pieces of paper,” said Scott A. Monteith, MD, a psychiatrist and health IT consultant, in The New York Times. This, he says, is something that cannot be done on today’s computer monitors or tablets. “It really affects how we think,” he adds about using the EHR.
It also changes how physicians practice. Howard Green, MD, wrote a terrific “buyer beware” article on LinkedIn about EHRs, essentially calling them a “bill of goods” without using those words. James Richard responded with a comment about how his office’s EHR obstructs care and seeks to control treatment decisions:
Using the Medicare Physical template, the program demanded an answer for the question, ‘Are there guns in the house?’ The encounter could not be closed until the answer was given. … On the College Physical template, if the patient was female, the program automatically opened the prescription window with a selection of birth control pills, all name-brand of course. The window could not be closed until a selection was made and printed, or if declined, a free-text explanation for not prescribing contraceptives had to be made.
The freedom of a pen and paper is gone. Physicians who must provide explanations for going against the computer’s treatment protocols are no longer in charge. Now outsiders, including the hospitals and health care systems that purchase the EHR systems and embed treatment algorithms have the upper hand.
The privacy of the paper chart or the “off the grid” EHR is also gone. Richard writes, “Our old EMR was absolutely private. No one could reach in from the outside to get the information. You would have to break and enter my office to access the program. The medical records in the new EMR are accessible to anyone in the world with a computer and internet connection.”
Patients are in danger. According to Scot Silverstein, MD, who specializes in medical records forensics consulting for litigation, EHR problems include “clinically important, related data elements scattered far and wide making physicians and nurses go on ‘wild goose chases’ or ‘click-o-rrhea’ (a term coined by an MD HIT user who wishes to remain anonymous) to relate them; diagnosis lists that place rare diagnoses near the top and common ones a hundred items below; boxes that hide part of diagnostic terms leading to incorrect selections.”
As a sign of the uncomfortable reality, the website Physicians Practice advertised a Jan. 6, 2016, “Breaking Up With Your EHR” webinar this way: “If you’re part of the vast majority of providers, you initially purchased an EHR to earn stimulus monies, but aren’t happy with the workflow, functionality, or vendor services. It’s time you stopped being held prisoner by an unsatisfactory EHR.”
A 1986 guidance document for Air Force software design noted, “To be sure, users can sometimes compensate for poor design with extra effort. Probably no single user interface design flaw, in itself, will cause system failure. But there is a limit to how well users can adapt to a poorly designed interface. As one deficiency is added to another, the cumulative negative effects may eventually result in system failure, poor performance, and/or user complaints.”
The same is true for patient care and the EHR.
Twila Brase, RN, PHN, is president and co-founder of the nonprofit Citizens’ Council for Health Freedom and is author of the new book, “Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records.”
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.