PracticalDermatology

For physicians, EHRs can mean headaches and hardships. But in the public sphere, sensibilities toward EHRs and their potential to streamline medical care have mostly been positive for several years. In the popular press, many articles about EHRs have exuded an aura of new possibilities, leaving many outside the medical industry with a rosier view of EHRs. Within the last year, however, that pendulum may have shifted. Several prominent articles investigated the difficulties of EHRs from a number of vantage points, such as security and cloning. (For coverage of this, see articles from the September and November 2012 issues of Practical Dermatology.) More recently, an article in The New York Times last month investigated a broader and potentially more unsettling angle regarding EHRs.¹

An Uncertain Future

The article highlights the findings of a new study from the RAND Corporation, in which the authors conclude that EHRs have failed to live up to the promise of an influential study by the very same group several years. The initial 2005 study from the RAND Corporation was so significant that it helped facilitate in the Federal government’s emphasis on Health Information Technology. The Times article also reveals the 2005 study was funded by General Electric and Cerner Corporation, two major players in EHRs whose profits have risen dramatically since the publication of the original study. Thus, not only are EHRs failing to meet expectations, but those very expectations may very have been built on a dubious premise, as well.

Many physicians will attest that the conversion from paper to electronic medical records is such a challenge that it may be hurting their bottom lines. For this reason, these findings are not likely to surprise many within the medical community. However, the implications of this recent report for the future of EHRs may be sweeping. Let’s start first with the government’s EHR incentive program, which will begin stage 2 next year—after a problematic run in Stage 1, no less. While earning incentive dollars was not a major challenge for most clinicians, the structure of the program does not reward those who take it into the later stages. In fact, the recent findings from RAND may provide some clinicians with more reason to accept the penalties of not converting to electronic medical records. All criticism of the program’s functionality aside, though, the deeper issue is that the government has now inextricably linked itself to the fate of EHRs in medicine, which means that if we continue down the path that the RAND study suggests, we might see more tweaks and greater penalties for not implementing EHRs into practice. This could spell many problems if profit margins do not see an uptick, as well.

In my last article, I noted that we are suspended in a long, sometimes ugly transition from analog to digital methods of documentation and medical practice in general. Younger physicians have less to worry about, as they will likely adjust more naturally to the changes that digital technology is bringing to healthcare. Nonetheless, a potentially more disconcerting reality may soon take shape if conditions continue along the downbeat path that’s increasingly been reported of late. While the problems physicians experience due to this technology are significant, the influence of EHRs extends well beyond those of us practicing medicine and into the realm of patients themselves. And if our patients’ experiences are affected negatively by the growing burdens of EHRs, this may only intensify the already fragile state of EHRs within the larger scope of healthcare.

Patient Experience is Key

The underlying message of the New York Times article is dismaying, no doubt, but this article and others are also meaningful because they may inform and reflect an ostensible shift in public sentiment toward EHRs. And considering that the Federal government’s incentive program will soon require patient participation, the ramifications for these murky relationships are potentially daunting. Of course, with more participation and familiarity, EHRs could very well meet the potential that was promised back in 2005. But if EHRs are to have a bright future, patient perception is going to play a major role in that. In fact, patient experience may be the determining factor for whether this uncertain state in which we now find ourselves is simply a difficult transition period or the permanent future of EHRs.

Mark Kaufmann, MD is co-chair of the Dermatology work-group for CCHIT. He is on the Medical Advisory Board of Modernizing Medicine.

1. Abelson R, Creswell J. “In Second Look, Few Savings From Digital Health Records.” The New York Times. January 10, 2013. http://www.nytimes.com/2013/01/11/business/electronic-recordssystems- have-not-reduced-health-costs-report-says.html