Electronic health records (EHRs) promise to do many things: improve patient care, streamline physicians’ workflow, facilitate research, and lower health care costs. But seven years after the Health Information Technology for Economic and Clinical Health (HITECH) Act mandated the adoption of EHRs in the United States, those promises have gone largely unfulfilled.
“The EHR systems currently in use don’t communicate with each other,” says Dr. Steven J. Stack, president of the American Medical Association. That not only impacts patient care but adds US $30 billion per year to U.S. health care costs, according to the IEEE Standards Association (IEEE-SA), which is developing standards in the area.
“Further,” Stack says, “EHR systems don’t consistently support clinicians providing real care” and “substantially change the ways doctors think and access information, dividing tasks in ways not consistent with how physicians work.
“Engineers and software designers think they are designing these systems to meet our needs; clinicians disagree. There is clearly a need for communication to help both sides.”
Stack was one of the speakers at the first IEEE Pulse on Stage, a forum held in February in Las Vegas. IEEE Pulse, the flagship publication of the IEEE Engineering in Medicine and Biology Society (IEEE EMBS), and JAMA: The Journal of the American Medical Association organized the event to start a dialog among clinicians who deal each day with EHRs and the engineers who design the systems. Chairing the event were IEEE Senior Member Colin Brenan, editor in chief of IEEE Pulse, and Dr. Edward H. Livingston, IEEE member and deputy editor of JAMA.
“One of the primary goals for our first Pulse on Stage was to bring together key stakeholders for a meaningful discussion about where EHRs are now, where it should be in the near future, and how we can get there,” says Nicole Randall, a spokeswoman for IEEE EMBS.
“Our goal is to be controversial,” Brenan said at the event, “by not only pointing out the problem areas but potential disruptive solutions to the status quo.”
The forum was held the day before the Healthcare Information and Management Systems Society (HIMSS) meeting, also in Las Vegas, to attract more EHR users. HIMSS is a global, not-for-profit organization focused on achieving better health through information technology.
To attract physicians, the AMA offered forum attendees continuing-education credits.
The forum’s speakers were from the health care industry, including the AMA, private health care systems, application developers, and care providers. They defined the problems that need solutions.
Some of the “meaningful use” mandates of the HITECH act, for instance, require inputting massive amounts of data, some of which only the physician is allowed to enter. “The mandate is turning MDs into clerks who spend time inputting data, rather than in patient care,” Livingston says. “Sometimes you even have to re-enter the same information in multiple places.”
He also says that, doctors have to use EHR technology that isn’t really ready yet: “It makes our work more difficult, increasing the cognitive burden while decreasing efficiency. Physicians feel increasingly frustrated and demoralized by cumbersome technology that interferes with their ability to provide first-rate patient care.”
Stack, an emergency-room physician in Lexington, Ky., has similar complaints. “The meaningful use program needs to be more flexible and supportive of innovations, rather than overly prescriptive,” he says. “Currently it mandates more than 120 specific tasks physicians must do—an incredible burden. Yet many of the requirements don’t improve quality of care.”
EHR vendors are too busy writing software to meet government requirements, he adds, and “desired technical capabilities that support clinical care have not been fully incorporated into EHR systems.”
Dr. Nancy Gagliano, chief medical officer for the CVS Health MinuteClinic program, points out that today’s EHR models were designed for functionality, not work flow. “There’s too much attention to bells and whistles but not enough on basic tasks,” she says. “To cut health care costs, the system should be designed to make physicians as efficient as possible.”
SOLVING THE PROBLEMS
To correct the problems, Stack says, what’s needed are “light-touch, right-touch regulations, where a little bit goes a long way.”
“Government regulation and standards would be best focused on promoting interoperability, data security, and design usability,” he says. “When government overspecifies exactly how things must be done, we get a one-size-fits-none paradigm that does not meet patient and physician needs.”
Adds Livingston, “What’s needed is a system designed around physician work flow—right now it’s the opposite. We need to figure out what it should look like, and the engineers need to tell us what is possible. Then it’s up to the medical community to drive through policy changes in government.”
To foster that sort of communication, future Pulse on Stage events are under consideration. Health-related topics being considered include neural science, neural engineering, and wearable sensors.
Whatever the topic, diversity of thought is key. Says Brenan, “We provide a forum where we initiate informative conversations that challenge the status quo and provide a vision of how to make the impossible possible.”