Viewpoint

The Unnatural EHR Marketplace

FROM THE CHIEF MEDICAL EDITOR Larry E. Patterson, MD

I have written much about the ramifications of EHR to our practices. In the last few years. I went so far last year as to actually implement an EHR system in my own practice. I write one more time one this subject, because of recent breaking news on this whole saga.

In 2005 a team of Rand Corporation researchers projected that implementation of this technology could save our health-care system more than $80 billion annually. Well, it’s 2013, and that did not exactly happen. Not by a long shot. In fact annual health-care costs have grown by $800 billion since the report.

What really happened? The original Rand report made several assumptions. Now, a new Rand report explains why it all went so wrong. (See At Press Time, “Study Redefines Potential of EHR,” page 10). Among the key failed assumptions, according to the latest report:

• “Are modern health IT systems interconnected and interoperable? The answer to this question, quite clearly, is no.” It would be nice if your system and mine talked to each other, but as this report notes, systems don’t always work well even when two groups purchase the same package from the same vendor!

• “Are modern health IT systems widely adopted? The answer here is no as well.” It turns out many if not most of the major systems that purchased the technology were going to do it anyway. Smaller practices are having a hard time making this work financially. This is a major reason why so many doctors are selling out to larger health-care systems.

• “Are modern health IT systems used effectively? Again, the answer is no.” While most agree that someday these systems will be much improved, for now there is little data showing any real improvement in productivity or patient safety. Just ask any physician in his or her first few years of transition. Productivity suffers greatly, and patient safety can take a back seat to trying to get the electronic record to cooperate. My favorite quote from the report was, “Unfortunately, major commercial vendors have not made usability a priority.”

• “Has appropriate change in health care been made? Sadly the answer here is no.” We still do everything the way we always did, but at least enhanced documentation now makes it easier to charge more. (Imagine winky-face emoticon here.)

EHR was making great strides naturally for years. But the government’s forced participation created an unnatural marketplace.We ended up with a situation that might have worked itself out in time.

My suggestion to you who are still deliberating installing EHR is the same: When you feel your practice is ready, go for it. Not because of incentives, and not because of penalties. Do it because you are convinced it is the right thing for your practice.