A revolt is brewing among doctors and hospital administrators over electronic medical records systems mandated by one of President Obama’s early health care reforms.
The American Medical Association called for a “design overhaul” of the entire electronic health records system in September because, said AMA president-elect Steven Stack, electronic records “fail to support efficient and effective clinical work.”
That has “resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients,” Stack said.
Congress approved the Health Information Technology for Economic and Clinical Health Act in 2009, which mandated the health care industry to undertake a massive digitization of patient medical records.
More than 75 percent of all physicians now use some type of electronic records system, up from 18 percent in 2001, according to the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
In a report sent to Congress Thursday, the office also said hospital adoption of at least a basic electronic records system has increased from 12 percent in 2009 to 59 percent this year.
The concept of digitizing patient records where they can be accessed in real-time by multiple health care providers is popular, but a lengthening list of problems with its implementation is prompting increasingly vocal complaints.
The complaints focus on poorer quality care for patients and fewer medical reports while immense new financial burdens are imposed on medical providers. In addition, the new digitized system leaves millions of people vulnerable to hacker attacks.
Obama referred to studies showing the program would save the country $81 billion, but that claim has all but vanished as costs have escalated, billing errors have increased and there are new worries about medical fraud.
Early signs of a budding rebellion among doctors appeared in a study done last year by the Rand Corp. for the AMA.
Many of the responding physicians said they spend too much time looking at computer screens instead of the patients they are examining.
“The intensity of the problems with electronic health records was something we did not anticipate,” said Mark W. Friedberg, a senior scientist with Rand, who managed the study.
Doctors reported “being concerned that they weren’t picking up on everything they needed to pick up on to give good patient care,” Friedberg said.
The programs “were not terribly well-designed in terms of limiting the amount of time the physician was forced to look at the computer rather than the patient,” he said.
The same worries are expressed on KevinMD.com, an Internet site used by thousands of doctors.
Putting computers in the examination room “forces providers to spend more time than ever staring at a computer screen and clicking checkboxes with a mouse to satisfy onerous billing and administrative requirements that do little to help patients,” said Kevin Pho, an internist who runs the site.
“In the end, electronic medical records are made to satisfy regulations,” Pho said.
Pho was also critical of the software powering the electronic medical records systems, saying “it takes me over 50 mouse clicks, all while scrolling through dozens of screens, to document a straightforward office visit for a sinus infection.”
Routine tasks have become more complicated as a result, Pho said. “Refilling a single prescription electronically, which I do over a hundred times a day, takes over 10 clicks,” he said.
Pho cited a study published earlier this year by the American Journal of Emergency Medicine that found doctors in community hospitals average spending 44 percent of their time in front of a computer and only 28 percent in direct patient care.
The title of the study cited by Pho was “4000 Clicks: A productivity analysis of electronic medical records in a community hospital ED.”
Similarly, the Rand study said “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, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”
Friedberg said one of the most common complaints he heard concerned the “degradation of clinical documentation.”
He said the software forces physicians to use rigid templates that can mislead other care providers about patient conditions and treatment, thus raising doubts about electronically transmitted diagnostic and treatment notes.
“A lot of text is ‘auto populated’ into the medical record. If you just click a box, it will document that you did an entire examination,” he said.
“Doctors don’t trust each other’s notes anymore in many cases because they see identical, replicated, huge blocks of text in these notes, and they know probably all those questions weren’t actually asked,” he said.
“Once you know there’s some false information in the record, why do you have faith in it? Is any of it true?” Friedberg said.
Obama promised that the use of computers would ease communications between doctors about their patients, but administration officials didn’t anticipate that vendors would sell unique software systems that can’t “talk” to each other.
As a result, doctors increasingly resort to sharing medical records by fax, defeating the entire purpose of the electronic program, he said.Friedberg's findings were confirmed today by Thursday's HHS report to Congress. "In 2013, only 14 percent of physicians shared patient information with any providers outside of the organization," the federal office reported.
Studies promised major savings with the new system, but all doctors and hospitals have seen is red ink.
Doctors were reporting a “negative return on investment” for deploying an electronic medical records program, according to Health Affairs, an industry trade publication in March 2013. The losses per doctor averaged $43,743.00, Health Affairs said.
Hospital administrators are having similar problems. At Maine’s 600-bed Medical Center in Portland, Me., CEO Richard Peterson told employees that inaccurate digital billing cost the hospital $13.4 million, according to a July 23, 2013, Healthcare IT News report.
"The launch of the shared electronic health records has had some unintended financial consequences," Petersen said, adding that “we've been unable to accurately charge for the services we provide. This lack of charge capture is hurting our financial picture."
Relying solely on electronic records can also endanger hospital patients when computers crash.
In January of this year, an IT network failure shut down for three days the electronic health record system at a three-hospital health system in Stuart, Fla., according to a Jan. 28 Healthcare IT report.
The same report stated that health records were inaccessible for a full day due to a network failure at the 24-hospital Sutter system in California.
Cyber-security fears that electronic records are vulnerable to hacking were confirmed in August when hackers hit the Franklin, Tenn.,-based Community Health Systems network of 206 hospitals in 29 states.
Records for 4.5 million patients were potentially compromised in the attack.
“That case was not an anomaly,” said Lillian Ablon, a technology and policy researcher who oversees cybersecurity issues at Rand. “They could commit identity theft and medical fraud. They could submit fraudulent insurance claims to get money.”
Other risks were involved as well, according to Ablon: “It means they could get into a medical network and access other pieces of the network where financial data is stored or other sensitive data.”