Growing pains in shift to digital records

Growing pains in shift to digital records

A massive transformation of the nation’s medical system is underway as doctors and hospitals migrate to digital records.
The shift promises to fundamentally alter medical care in the United States by introducing standard information technology across the system.


A uniform electronic health record will give doctors a more complete picture of a patient’s medical history, including data from other clinical settings that might be missing in a paper record.
But healthcare providers say they are struggling with the transition under the federal “Meaningful Use” incentive program that was designed to speed progress.
Four years after its rollout, hospitals and doctors say the electronic health records (EHRs) initiative is hampering their ability to deliver care.
“These software programs have deprived us of our efficiency, taken us away from interacting with patients and forced us to be secretaries and clerks,” said Dr. Steven Stack, a past board chairman of the American Medical Association (AMA).
“These are real frustrations for physicians, and they need to be addressed with a mid-course correction in the program,” he said.
Defenders of “Meaningful Use” argued the effort is essential for reaping the benefits that EHRs will provide, including fewer fatal medical errors.  
“People are dying every day because doctors missed a crucial detail about their medical background or the progress of their care,” said Robin Raiford, a senior research director at The Advisory Board Company.
“At a doctor’s office, you are only as safe as the information they know about you, and without an electronic record, that information is usually incomplete.”
The Obama administration said it is listening to the criticism from healthcare providers and demonstrating flexibility with delays and exemptions.

Federal health officials slowed down the process again for doctors and hospitals in a proposed rule released last month.
“Many of the organizations are saying this is too much. We are sensitive to those concerns,” said Jacob Reider, deputy national coordinator for health IT.
“We also think there is an urgency to get this work done. If it doesn’t get done, then our care delivery system continue to manage itself in the inefficient and potentially wasteful way it has.”
The conflict highlights a disagreement over how best to hasten the adoption of medical IT and how complex government regulations on the matter should be.
Though medical devices are on the cutting edge, few industries remain as far behind on electronic recordkeeping as healthcare.
“Since the days of Hippocrates, healthcare records have been on paper. Every industry has already converted to digital, and healthcare is the one that still has not done it,” said Jim Tate, president of consulting firm EMR Advocate.
Underscoring the technological vacuum, medical providers are rarely in communication with one another even when treating the same patient.
These problems can pose a host of risks.
As patients transition from a doctor’s office to a hospital, or a hospital to a nursing home, clinicians rarely have a full picture of what other caregivers have done before.
“For all of time, our medical system has been focused on single units of care, like a doctor’s appointment or a hospitalization. There wasn’t a lot of information-sharing,” said Raiford.
The medical community is aware of the dangers, which were crystallized in a 1999 Institute of Medicine report finding that medical errors cause between 44,000 and 98,000 deaths each year.
By the time of the report, healthcare providers had embarked on a disjointed effort to adopt better information technology that could help ease administration and avoid errors. But a pronounced shift did not start until after 2011, when “Meaningful Use” got off the ground.
Stack of the AMA acknowledged said government intervention was necessary to spur the adoption of health IT.
“To give credit where it is due, ‘Meaningful Use’ has brought together countless stakeholders to work together,” he said. “There is a success story to be told here.”
The three-step program is now starting to enter Stage 2, though only four hospitals and 50 doctors had achieved that level of progress as of mid-May, according to the Centers for Medicare and Medicaid Services.
The program has already experienced a series of delays. Stage 3, which is focused on using data and technology to improve care outcomes, will not begin until 2017.

If it is finalized, the latest delay will prevent penalties from hitting doctors and hospitals that fail to move into Stage 2 on time, even if they do not apply for a special exception.

The regulation would also extend Stage 2 through 2016.
Still, federal health officials say there are already noticeable improvements from the last three years of work.
A “Meaningful Use”-driven effort to clear up prescription errors has already produced results for many patients, argued Reider.
“Mistakes in recording, when a prescription is scribbled and hard to read ... and mistakes in prescribing a medication that the patient is allergic to are much less frequent,” he said.
“We’re not finished,” he added. “The second stage of the program has only just begun.”
But providers said the program continues to disrupt their work, particularly as they encounter issues with the software.
“It is forcing hospitals and physicians to use technologies in ways that may not be most beneficial and most appropriate for their strategic goals, or frankly, for their patients,” said Chantal Worzala, director of policy with the American Hospital Association.

— This story was updated at 5:44 p.m. on June 5.