Are Electronic Health Records the Answer?

Now that Obama has told people that health IT is on his radar screen for public investment, all the interest groups are lining up. Below are some excerpts from a blog post by the head of the Commission on Health Information Technology, a nonprofit group that certifies electronic health records (EHRs) for standards, functionality and interoperability. For a while now, health record products have been applying for certification by his group. Plus, he's a former physician. He's not uninformed. But I can't really agree with him.

... even a 1% improvement in the efficiency of our $2.2 trillion healthcare spend would put us in positive payback territory... Most doctors know they need EHRs and many will respond to an economic push right now. And the industry supplying those EHRs is a competitive, diverse marketplace that will respond to growing demand with increased capital investment and job growth.

I disagree that most doctors know they need EHRs. I've been working with small practices trying help them decide on deployment for years, and the word in the physician community, at least in Arizona, is that most of the deployments do not save time or costs as they are supposed to. This is partially because the products are complex and require a great deal of training as they are built now. The worst are the industry leaders in use by many hospitals. The doctors are trying to wait it out until they can retire, except for the younger ones who grew up with IT and demand it. This creates enormous conflict in any practice of more than a single doc: each provider has a different theory and a different need and a different favorite.

To make it more complex, the turnover in medical support personnel, front office and back office, is often frequent, so the training on these complicated products is ongoing and expensive. Support, services and training are the model by which some of these software companies increase their revenues.

Outright grants may be appropriate for providers in rural and underserved areas, and for safety-net clinics, but in other environments financial incentives should be structured as a series of incremental rewards for progressive achievements. In the private sector, the Bridges to Excellence program sets an excellent example, while the recently launched Medicare EHR Demo provides a public sector prototype. These programs offer initial incentive payments for purchasing appropriate technology - a certified EHR -- then a second round of money when successfully implemented. Beyond that, bonuses are paid only as the provider demonstrates improvements in quality or efficiency. Healthcare payment reform and healthcare IT -- twins separated at birth - must grow up and mature together to achieve their full potential.

I am about to see if my own providers are part of the Arizona Medicare EHR demo so I can sign up. But the people who see Medicare patients, already squeezed by lower Medicare payments, may have difficulty finding the time to implement software while seeing the huge volumes of patients they must now see to keep their offices open.

...some of the stimulus funds should be used to develop the skilled workforce needed. It may be possible to redeploy IT personnel from other industries to lay broadband infrastructure for healthcare, but we'll also need to boost health IT training programs. And doctors and nurses being asked to change their habits are best motivated by one of their own - a clinician champion. There are plenty of clinicians who have successfully led these projects, and we can't afford to have their experience locked up within their own organizations -- let's find a way to put them on a health IT inspirational speaking circuit.

Speaking circuit? We've had those for a while, but the doctors are too busy to show up!

Here's the only part I think has any hope. Shift from the doctors (the supply side) to the demand side. Otherwise EHRs are a band-aid.

You've also wisely recognized the need to redirect our health efforts toward prevention, helping people make better choices early in life, and eventually reducing the burden of expensive interventions near the end. To do this, we need to empower citizens with health knowledge, allowing them to make better health choices and to become more discriminating healthcare consumers. Personal Health Records (PHRs) will emerge as a platform for this new information flow. The organization I lead is also preparing to certify these PHRs, to ensure they are secure, private, and can exchange information with EHR systems in doctors' offices and hospitals. Projects in this field are a promising area for government investment.

This part I would like. Many citizens want their records in their hands, and if the central repositories (insurers, pharmacies, hospitals, Medicare/Medicaid) could be "forced" (incented) to dump their data into a PHR, we could help solve this problem. I have a PHR, but I can't populate it very easily, and since part of it consists of scanned pieces of paper, I can't search it or see trends. I look for someone like Microsoft or Google to help with this; they are already in the space with products I've tried.

...our current model is amenable to improvement with an assist from better information. With better data on prices charged and quality of care delivered, we can reform payment to reward clinicians for the quality or their work, instead of just for the quantity. With EHRs that easily intercommunicate, we can reward better teamwork among providers to re-integrate care despite our fragmented healthcare business model. And with empowered health consumers and an online connection that extends beyond the occasional visit to the doctor, we can motivate healthy lifestyles and prevention, eventually reversing the growing burden of chronic diseases.

Amen, brother. Bring on Health.2.0! It's already out there in hundreds of online patient communities trading information. That's where the inspirational speaking tour should begin -- with the patients, not the doctors.