Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting an article on interoperability challenges as well as our 2017 technology survey results. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.
David Wasserman spends his days advising physician practices throughout Massachusetts on EHR implementations, value-based care, and compliance and coding. He's an advisor with the practice solutions and medical economics group at the Massachusetts Medical Society. Physicians Practice recently interviewed Wasserman to get his perspective on the EHR interoperability challenge and its impact on physician practices and patient care.
Leann says: A single-payer, Medicare for all health care system in the U.S. could support one, centralized EHR that all providers and patients utilize. It works well in Denmark.
Michael replies: Leann, a centralized EHR may not be the best design for cost, physician engagement, patient engagement, patient-directed exchange of health information, and most importantly, data security. Although it seems like the most direct answer to the interoperability question, the side effect of decreased data security and decreased transparency of where and who that data goes to becomes exponentially problematic. Other countries that have universal healthcare and have instituted some form of a centralized EHR are beginning to experience and realize the risks involved with such a system.
Cynthia says: I am all for a centralized system, [with] one place for all records and the patient uses one sign-on to access all their records. Every EHR today is basically built for billing and data mining used for time wasting reporting to the government, it does nothing to help provide better care for the patient. The best way to better care and lower cost is to get the government out of healthcare.
Leann replies: All evidence is against you. Countries with the longest life expectancy, and the lowest cost of healthcare, all have high government involvement.
R Kim replies: It may be that the only data gathered is that from the government in other countries, thus 'it' looks good. The government, in our country, already runs the military health systems, the VA and Indian Health Service. Having grown up in the IHS, it is very poorly ran. And, more importantly, natives have some of the worst health status among any group of people in our country. The government and insurance companies need to give healthcare back to the providers and keep it between the sacred privilege that we have with the patient.
Practices across the country have graded the health IT industry, and it's not a pretty result. In fact, the health IT industry will have to get its parents to sign its report card because its grade is that bad.
Nearly 75 percent of practices agree with former CMS Administrator Andy Slavitt, has failed because physicians do not like the technology they use for the most part. This is according this year's annual Physicians Practice Technology Survey, which looks at the usage of technology at the practice level from more than 500 (mostly independent) practices across the U.S.
Joanne says: I think it would be helpful to have a "lemon law" for EHR systems, because they are so expensive for practices to buy and many small practices don't have the expertise to make an informed choice before purchasing. When the practice realizes it has bought a bad system, it is too difficult and expensive to change to another system. There needs to be industry standards on what each system should include to make it relatively easy to learn and use, and the EHR companies need to be required to provide adequate support, including training of new employees as time goes on, instead of the practice having to pay for training of the inevitable new employees
Leon says: I don't think that the IT industry is mostly to blame. They were asked to produce, and we were goaded into buying and using systems that really were, and in many ways still are, in their infancies. The understanding of how to meaningfully reflect the patient-physician encounter in a database with a common protocol or language that can be viewed across systems has not been well developed. Imagine if Harry Truman had ordered the U.S. to send a ship to the moon by 1952. The technical and scientific knowledge was simply not developed at that point. Yet, this is what happened with EHRs. We were the guinea pigs for many mission failures. The Feds should simply lay off and let the technology develop. When it is ready, we won't need to be bribed into using it.