Although we may believe otherwise, a careful look at how the EHR industry came to dominate our practices was not a stealth operation. Instead, it was a series of shrewd tactical decisions and complacency on the part of regulators that has led to the current debacle.
The story begins in 2009, when the intertwined relationships between the EHR industry, government regulators, hospital systems and doctors became even more entangled with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH). Because of the alluring financial incentives it created, this Act spurred the adoption of EHRs by hundreds of thousands of doctors.4 Although the goals of the Act seem worthy, there appears to be a major flaw in its objectives. In the years leading up to its passage, many meetings were held at the White House for the key players in the EHR industry, representatives of the information technology departments of several major healthcare systems and administrators from the Department of Health and Human Services. Their goal was to formulate the basic rules that would be used to create a massive, national electronic records interchange.
No doubt for clinicians, a key—if not the most important provision—would have been the requirement that medical records be readily transferable from one doctor to another across all health systems. When doctors think of medical records, this is likely their primary definition of a well-functioning EHR. It was assumed that barriers would vanish, allowing physicians everywhere to share the up-to-date records of mutual patients. No longer would there be a need for wasteful reams of paper to be manually copied, faxed, scanned and finally deposited into the record as a patient moved from one system to another. In essence, this stipulation would have acknowledged a very critical point, which is, the patient rather than the healthcare system owned their medical records.
Not only was this lofty goal not achieved, but the target for establishing standardized interoperable patient records has been kicked down the road for at least another decade. In political speak, this means likely never to occur. As John Halamka, MD, the chief information officer of the Beth Israel Deaconess Hospital in Boston, succinctly says, “You know, there are forest people, and there are tree people. Standards folks are, by necessity, bark people. They’ll spend a day debating the relative merits of an ampersand or a semicolon.”5
Not much point for us to be barking at the moon.