A strong vote of confidence in our EHRs from current users

I just ran across a blurb today pointing to this article on the web discussing changes in EHR purchasing between 2010 and 2013.  I acknowledge that I have not done full due diligence to examine their methodology and biases, but I see no reason to believe that the figures they present are grossly distorted for any obvious reason.

Briefly, what caught my attention is that the proportion of those looking to buy an EHR in 2013 vs. 2010 who are replacing an existing EHR jumped from 21% to 31% (but this article suggests it could be as "low" as 17% in 2013).  My first thought was that maybe these were people changing from discontinued/unsupported systems; this is why a couple of community health centers I know of here in Massachusetts made that move, because they had MISYS and AllScripts bought and shot it.  However, a bit farther down, data are shown that by far the largest reason for switching was dissatisfaction with the old system and this was more common in 2013 than 2010, with >60% citing this as their reason for switching in 2013.  Given the issue of EHR lock - the systems are very expensive and vendors make it as hard as possible to get your data out to move to another EHR (generally not even providing users a data dictionary to understand how their own patient data are stored) - jumping ship to another EHR because of dissatisfaction means you really hate the one you have.  Then think about all the costs of retraining clinical and support staff for the new EHR, the lost productivity as they go through another learning curve - the costs are likely not much lower than buying an initial system, though I've never seen any articles with data about the costs of switching.  You truly have to hate your EHR to switch because you don't like it rather than because it is no longer supported or doesn't qualify for Meaningless Use incentives.  (And let's not even think about the poor schmoes who bought an "EHRMagic" EHR and learned that the magic was that their MU certification would disappear.)

Strong incentives to buy black box products with penalties coming soon for not using them (e.g., not using e-prescribing), when there are huge exit barriers, bears no resemblance to the assumptions of a "free market."  I really wish that the "anti-big government" forces in Congress would go after this one.  Unfortunately, as we all know, they are quite happy with a forced subsidy to big business, even at the price of more expensive, lower quality health care and worse health for Americans.  But nobody gets elected, or voted out of office, on the basis of their positions and votes related to EHRs, do they?

And I can think of no better way to end this rant than with a turkey photo or two.

Your HIT parade - Problem lists!

As some know, I think our national electronic health record (EHR) policy is woefully misguided - providers/organizations are being pushed hard to buy an EHR, any EHR (I think the official title of this strategy is, "Let 1,000 EHRs fester"), with the costs of acquisition and barriers to exit so high that most purchasers get locked into whatever they buy, even after discovering it is a POS and most of what they were promised was vaporware.  These complex systems are devoted to charge capture/justification, not patient care, and are chief suspects in increases in Medicare coding intensity/costs unrelated to any actual changes in care. (Here's the NY Times article.)  Well, duh!  They are NOT, in general, focused on helping clinicians actually provide better care (except for the few that were actually developed by clinicians to help them practice).  However, I can think of few ways to make this clearer than the email I received today:

Health Resources and Services Administration

Health Information Technology and Quality Improvement Webinar

Friday, May 17, 2:00 PM ET

“Using an Electronic Health Record to Create Patient Problem Lists”

This webinar will focus on how safety net primary care providers can meaningfully use electronic health records (EHR) to create and maintain patient problem lists.  Created by EHRs, patient problem lists are a core requirement of Meaningful Use. This function serves as a powerful tool for maintaining a patient’s medical history while also helping to engage patients to better track and manage their health care.  

Presenters will demonstrate how patient problem lists are created and maintained by EHRs, and share their strategies on how providers can use them for quality improvement and patient engagement.  Lastly, staff from the U.S. Department of Health and Human Services will discuss the importance of patient problem lists in achieving Stage 1 and 2 of Meaningful Use.

Register here: https://cc.readytalk.com/cc/s/registrations/new?cid=3g2cm558x3gp.

Previous HRSA Health IT and Quality Webinars can be accessed at the HRSA Health IT and Quality Webinar website: http://www.hrsa.gov/healthit/toolbox/webinars/.

Questions for presenters are welcome prior to the event and may be emailed to healthit@hrsa.gov.

If a webinar is needed to help people learn about creating problem lists in their EHRs and discuss how they can be useful in patient care, we are in seriously deep trouble.  After being sure you are looking at the right chart, the problem list is typically the first thing you look at.  How can it be possible that we are pushing people to buy and use such useless crap where conducting such a webinar does not seem utterly nonsensical?  And that people are paying many thousands, and often millions, of dollars for these pieces of crap.

Don't get me wrong - as a geek, I think the EHR has huge potential for increasing the efficiency and effectiveness of health care.  I just think we are squandering nearly all of that potential with our current, misguided policies and driving costs up substantially with little or no payoff.  Except to the EHR companies, who are making billions.  "Free market" Republicans should be up in arms over this forced subsidy - except, of course, they really care about helping businesses make money, not free markets, competition, efficiency, or saving taxpayer money.

Stay tuned - I hear that next year, HRSA and ONCHIT are planning on cosponsoring an advanced-level webinar, "Creating a Progress Note Using an Electronic Health Record."