Doctors, Hospitals Rethinking Electronic Medical Records Mandated by 2009 Law

By Pollock, Richard | Examiner (Washington, D.C.), The, October 10, 2014 | Go to article overview

Doctors, Hospitals Rethinking Electronic Medical Records Mandated by 2009 Law


Pollock, Richard, Examiner (Washington, D.C.), The


A revolt is brewing among doctors and hospital administrators over electronic medical records systems mandated by one of President Obama's early health care reforms.

The American Medical Association called for a "design overhaul" of the entire electronic health records system in September because, said AMA president-elect Steven Stack, electronic records "fail to support efficient and effective clinical work."

That has "resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first- rate medical care to their patients," Stack said.

Congress approved the Health Information Technology for Economic and Clinical Health Act in 2009, which mandated the health care industry to undertake a massive digitization of patient medical records.

More than 75 percent of all physicians now use some type of electronic records system, up from 18 percent in 2001, according to the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

In a report sent to Congress Thursday, the office also said hospital adoption of at least a basic electronic records system has increased from 12 percent in 2009 to 59 percent this year.

The concept of digitizing patient records where they can be accessed in real-time by multiple health care providers is popular, but a lengthening list of problems with its implementation is prompting increasingly vocal complaints.

The complaints focus on poorer quality care for patients and fewer medical reports while immense new financial burdens are imposed on medical providers. In addition, the new digitized system leaves millions of people vulnerable to hacker attacks.

Obama referred to studies showing the program would save the country $81 billion, but that claim has all but vanished as costs have escalated, billing errors have increased and there are new worries about medical fraud.

Early signs of a budding rebellion among doctors appeared in a study done last year by the Rand Corp. for the AMA.

Many of the responding physicians said they spend too much time looking at computer screens instead of the patients they are examining.

"The intensity of the problems with electronic health records was something we did not anticipate," said Mark W. Friedberg, a senior scientist with Rand, who managed the study.

Doctors reported "being concerned that they weren't picking up on everything they needed to pick up on to give good patient care," Friedberg said.

The programs "were not terribly well-designed in terms of limiting the amount of time the physician was forced to look at the computer rather than the patient," he said.

The same worries are expressed on KevinMD.com, an Internet site used by thousands of doctors.

Putting computers in the examination room "forces providers to spend more time than ever staring at a computer screen and clicking checkboxes with a mouse to satisfy onerous billing and administrative requirements that do little to help patients," said Kevin Pho, an internist who runs the site.

"In the end, electronic medical records are made to satisfy regulations," Pho said.

Pho was also critical of the software powering the electronic medical records systems, saying "it takes me over 50 mouse clicks, all while scrolling through dozens of screens, to document a straightforward office visit for a sinus infection."

Routine tasks have become more complicated as a result, Pho said. "Refilling a single prescription electronically, which I do over a hundred times a day, takes over 10 clicks," he said.

Pho cited a study published earlier this year by the American Journal of Emergency Medicine that found doctors in community hospitals average spending 44 percent of their time in front of a computer and only 28 percent in direct patient care.

The title of the study cited by Pho was "4000 Clicks: A productivity analysis of electronic medical records in a community hospital ED. …

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