Marion Mass and Kenneth A. Fisher March 20, 2018 6:31 p.m. ET
The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it's done for retail.
EHRs were forced on the health-care community by the 2009 stimulus. Congress has allocated $37 billion so far to help providers upgrade from mostly paper files. Nearly a decade later, the promised efficiencies and savings haven't materialized.
Instead, EHRs divert doctors' attention from patients. Physicians often rely on visual cues when taking a patient history, but now what's visible much of the time is a computer screen. The outdated EHR technology is difficult and time consuming, contributing to doctors' stress and burnout. The unintuitive interfaces consist of multiple drop-down menus and forms as well as countless boxes to check and pages to navigate. The screen often freezes. It takes seven clicks to order basic antibiotics, 14 clicks to order stronger ones. It's death by a thousand clicks, and it's killing the medical profession.
We physicians have the longest training time of any profession, yet we now spend roughly two-thirds of our workday as data-entry clerks, tending to digital paperwork and administrative burdens. A Johns Hopkins study finds that paperwork requirements have significantly reduced the amount of time new doctors spend at patients' bedsides, limiting their clinical skills. EHRs are also contributing to doctors' taking early retirement. According to a survey published in Medical Economics, two-thirds of doctors dislike the functionality of their EHRs. Even more say the conversion to EHRs has not been worth it.
The clunky EHR systems distract us from the thinking necessary to make diagnoses. A Harvard-affiliated study found that 147 times in roughly 5,700 cases, EHRs contributed to "adverse events." Half were serious and one-third fatal. The ECRI Institute, a patient-advocacy group, designated EHR hazards as the No. 1 patient-safety concern for 2014. An example from the front lines: Clonidine, a blood-pressure medication, sometimes gets prescribed instead of Klonopin, a seizure drug, because medical professionals click the wrong box.
EHRs fail to achieve one of their main selling points, interoperability-the ability to share records across providers and systems. Competing systems are generally incompatible with each other. A 2016 KLAS Research report finds only 6% of health-care providers say they can effectively access EHRs between different systems. Thus patient records still must be faxed among providers. It's like having a computer that can't connect to the internet.
Why are EHR systems so primitive? Partly because vendors must be certified as compliant by the Department of Health and Human Services, inhibiting better products and insulating existing ones from best-in-tech competitive pressures.
This market protection leads not only to lower quality but also higher prices. EHRs are extraordinarily expensive, with taxpayers, providers and patients footing the bill. For private hospitals, EHR conversion costs anywhere from $40 million to $353 million. Individual physicians spend an average of $32,000 a year on upkeep. All these costs are ultimately passed on to patients.
In announcing the Trump-administration initiative, White House aide Jared Kushner and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said health-technology companies, insurers, doctors, hospitals and patient groups have been working together for six months on an initiative called MyHealthEData to modernize EHRs and achieve interoperability. But the usual suspects can only do so much. This is a market begging for competition from the likes of Amazon, whose cost-cutting and ease-of-use expertise is well established. Apple has also made a welcome entrance into the market. The administration can help by directing HHS to allow EHR competition.
Doctors and patients deserve cutting-edge technology that would offer such features as wearability, automatic audio and photo uploading to a digital chart, encrypted cloud storage for easy access, and compatibility across platforms in different locations. These features are already available at relatively low prices in consumer products.
Ultimately, EHRs must enhance the doctor-patient relationship, not impede it. Sounds like a task for the Everything Store.
Dr. Mass is a pediatrician. Dr. Fisher is a nephrologist and author of "Understanding Healthcare: A Historical Perspective." They are, respectively, a co-founder and an advisory board member of Practicing Physicians of America.
Appeared in the March 21, 2018, print edition.