Part 2: The Problem with Electronic Health Records

The Problem with Electronic Health Records

In Part 1 of this series, I spoke about the benefits of Electronic Health Records (EHRs). But they do not come without problems.

One of my goals as a physician is to understand the needs of the individual patient and the specific population that we serve.

Yes, Electronic Health Records (EHRs) help, but they alone cannot enable physicians (1) to eliminate variability in outcomes and (2) to understand both individual patients and full patient populations.

Obviously, use of some kind of EHR-type solution is both a cogent and necessary demand if you desire to understand an entire population of patients, but it undoubtedly comes with more than a few unintended consequences. It may produce better outcomes and drive down costs, but it also devours provider hours and creates record-keeping and compliance migraines.

Indeed, EHR usage can infuriate both physician and patient. For example, the ubiquitous EHRs interrupt the time physicians and patients spend interacting. Providers will likely be unsurprised to know that an American Medical Association survey found that physicians were spending more time on EHR documentation than on patient care.

On the whole, the medical community arguably gains relatively little value from the change to EHR-driven care.

The EHR promised the Holy Grail of medicine – improved outcomes at a lower cost – but the reality has been a mixed bag, with most studies showing no significant improvement in either metric.

Certainly, some positive results have been achieved. We’ve seen a significant decline in medication prescribing errors, for example.

But the profusion of data has not been translated into actionable information for most providers, healthcare systems and payers.

A 2016 report from the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) found that in 2015 nearly four out of five (77.9%) office-based physicians had installed and were using EHRs, but “only a third of physicians had used their EHR system to either send, receive, integrate, or search for patient health information and only 8.7% of physicians had used their EHR system for all four of those functions.”

Part of the reason is that most small medical practices do not have the resources to mine the data within their EHR. In addition, much of their historical data as well as a host of new reports still in unstructured form – like scanned paper reports – are not translated into discrete data fields in the EHR. Indeed, the Health Story Project “estimates that some 1.2 billion clinical documents are produced in the U.S. each year, and about 60 percent of these contain valuable patient-care information ‘trapped’ in an unstructured format.”

These factors make it nearly impossible for the typical medical provider to find the data, let alone make informed decisions based on information that resides in the EHR data base.

So what’s one solution? Read Part 3: Building Structures to Share Data.

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