Electronic Health Records

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Has Adoption of Certified EHR Technology Trapped Docs?

Add "bear trap" to the list of metaphors used to criticize certified EHR technology.

By Kyle Murphy, PhD

In a recent editorial published in the Journal of American Physicians and Surgeons, the journal's editor-in-chief and practicing neurologist Lawrence Huntoon, MD, PhD, has criticized the Centers for Medicare & Medicaid Services for its handling of EHR adoption as part of the EHR Incentive Programs.

Chief among his complaints are the federal agency's efforts to recoup EHR incentives from eligible professionals who as part of meaningful use audits were determined to not have satisfied the necessary meaningful use requirements.

"In summary, the government’s EHR Incentive Program for some physicians was nothing more than a giant bear trap with a wad of cash in the middle for bait," he writes.

According to Huntoon, current EHR technology is financial rather than clinical in its design and use.

The main purpose of a medical record is to provide a physician or other person taking care of the patient with information about what is going on with the patient. It allows a physician to track the patient’s diagnoses, treatment, and progress from one encounter to the next. And, should something happen to the treating physician, the medical record should contain sufficient information such that another physician can take over the patient’s care. Unfortunately, due to the intrusive power of government and other third-party payers, the medical record has been bastardized into a billing record that often has little or no clinical relevance. The emphasis is on complying with “bulleted” points so as to justify a certain level of billing to the third-party payer.

The neurologist and editor's criticism of certified EHR technology also includes the potential for abuse in either the form of healthcare fraud or health data breaches.

Of the former, he calls attention to the practices of EHR upcoding and cloning, which became a subject of national debate in 2013 following reports that many providers relied on these practices in their EHR use.

"So, in many cases the EHR has become a completely fictitious record. An EHR consisting mainly of fictitious, fraudulent entries does not improve quality of care or patient safety, and is not efficient or relevant," claims Huntoon.

As for health data privacy and security, Huntoon's criticism makes no room for secure and confidential electronic information, only noting that EHR use makes patient data "easily accessible to hackers" and curious employees.

The remainder of Huntoon's diatribe against certified EHR technology focuses on physician EHR use and its consequences. For one, he argues that increased physician computer use erodes the foundation of the provider-patient relationship.

"With the 'new and improved EHR,' however, the physician frequently turns his back on the patient and is focused on the computer, making sure to enter information in all of the fields so that payment can be secured," he writes. "The physician may not even be listening to what the patient is saying because he is distracted by the requirements of the EHR."

But the negative effects of physician EHR use don't end there, says Huntoon. Certified EHR technology is also contributing to physician burnout as a result of poorly designed systems.

"Physician frustration with poorly designed EHRs, which consume an inordinate amount of time and offer little or no benefit for patient care, is a major contributory factor to physician burnout. Physicians who are burned out provide poor patient care and have worse patient outcomes," he adds.

Huntoon's comments come within days of American Medical Association Executive Vice President & CEO James L. Madara, MD, criticizing the abundance of digital health tools that have failed to prove beneficial to providers and referring to them as the "digital snake oil of the early 21st century."

"More and more we're seeing digital tools in medicine that, unlike digital tools in other industries, make the provision of care less, not more, efficient. And these digital tools often don't connect with each other—interoperability remains a dream," he told attendees of the AMA annual meeting. "We were told that interoperability was the future; we didn't expect that it would always be in the future."

Dig Deeper:

Ensuring Physician EHR Use Doesn’t Lead to Physician Burnout
AMA: EHR Interoperability Part of Today’s Digital Snake Oil




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