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The EHR: Meaningless Use

It’s hard to imagine living without computers and the Internet. Many processes have become faster, more accurate, and even fun. So why is it that the electronic health record is such a disaster? Poll after poll demonstrates the frustration, expense and bitterness among physicians. The reality of meaningful use is anything but meaningful. A 2013 report by the RAND Corp. and the AMA cites nine negative and only three positive outcomes: “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

EHRs are creating financial burdens, causing many physicians to move from private practice to employment. Fifty-three percent of physicians seeking employment cited meaningful use as one of their top reasons for leaving private practice, according to a November 2012 report by Accenture. A follow-up survey released in July 2015 shows a steady decline in physician-owned practices: currently only 33% of physicians, down from 57% in 2000.

It’s no wonder why: for a five-physician practice, implementing an EHR costs $162,000, even with incentives of up to $44,000 from Medicare and $63,750 from Medicaid. Those incentives don’t cover annual licensing fees, ongoing costs for hardware and Internet service, the unanticipated hiring of staff such as scribes and IT managers, plus lost physician productivity. EHRs can place small practices in economic jeopardy.

Concern is growing that EHRs increase physician exposure to medical malpractice litigation. Errors in EMRs are common; 84% of electronic charts in a VA study had at least one error. Lack of eye contact during the office visit diminishes the doctor’s ability to build rapport and communicate effectively. Ignoring alerts and clinical decision support tools, whether through fatigue or conscious decision, also exposes physicians to risk. The tone of email communications can be easily misinterpreted by patients. Having a scribe in the room is another potential source of patient dissatisfaction. And security breaches of sensitive health information are always a real threat.

The RAND report summarizes the state of EHRs in medicine best: “EHR usability represents a relatively new, unique, and vexing challenge to physician professional satisfaction. Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, which has, as our findings suggest, not yet matured.”

What can we do? There is a two-part solution. First, share with the Chicago Medical Society your real-life examples of EHRs interfering in patient care. CMS educates lawmakers about daily practice hassles. Few understand the complexities of EHRs, and so we explain the physician learning curve and the impact of proprietary enterprise software systems on patient care. EHRs actually handcuff patient data because of proprietary software and technology protections. A CMS committee is studying EHR issues with the goal of developing policy and jumpstarting legislation. Just as our advocacy eased the ICD-10 requirements, CMS can achieve more flexible EHRs.

The second step is support for a new bill (HR 3309) introduced by U.S. House Rep. Renee Ellmers (R-NC) called the “Flex-IT 2 Act.” The bill would pause meaningful use rulemaking, remove the pass-fail approach, align quality reporting, expand the hardship exception to EHR payment adjustments, and promote interoperability.

If you are fed up with your EHR, please urge your congressional representatives to support HR 3309. And be sure to work through your Chicago Medical Society.

Kathy M. Tynus, MD
President, Chicago Medical Society

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