For keen students of American politics, the unending intrigue of the 2016 presidential race has been riveting. With an assemblage of aspiring candidates that, at its start, included a bevy of U.S. senators and former governors, a media-savvy real estate mogul, a renowned Hopkins neurosurgeon and an ophthalmologist, political junkies among us have feasted on the endless buffet of debates, town hall meetings and candidate interviews. Seemingly every headline, video clip and Twitter feed is focused on the next state primary and the latest delegate tally, leaving us with precious spare time to peruse some of the equally engaging events in the world of healthcare and science that have impacts on our professional and personal lives.
Several such stories have been previously covered in this column. However, like the presidential race, some have taken a few unexpected twists and turns that deserve a second look.
The Debacle of Electronic Health Records (EHRs)
It was not so long ago that pen and paper were the favored tools used to scribble and store patient medical data. Notes were often lengthy, messy affairs, but worth a careful read in search of precious insights into the patient’s condition. Differential diagnoses were discussed, and opinions were rendered. Reading through a patient’s record was a useful exercise. But the lack of digitization kept the ink-and-paper medical record isolated from the rest of the connected universe (see “How Non-Transferable EHRs Have Affected Physician Practices,” The Rheumatologist, July 2015).
Physicians have long realized this state of affairs had to change. We are not Luddites. But getting a majority of the 600,000-plus American doctors to abandon their filing cabinets and replace them with hard drives and clouds was not going to be easy. By using plenty of carrots (e.g., about $35 billion in incentive payments) and a few sticks (e.g., threatened reductions in Medicare reimbursement), the Department of Health and Human Services succeeded in converting nearly five out of six physicians to an electronic record, a formidable achievement accomplished in less than a decade.1
Initially, most physicians welcomed this change. Why not? There were countless promises of how the EHR would revolutionize care by making records readable and readily accessible to doctors and patients alike. Patient flow would improve, and providers would be able to share the same electronic record, which would follow the patient wherever they received their care. Digital nirvana would be achieved.
Yet there was one critical error in this construct. We—the practicing physicians, the actual hands-on users of these systems—were never invited to sit at the table and actively participate in EHR development. Instead, a cabal of government bureaucrats, EHR company executives and their software developers hashed out the rules.2 Now, we are paying dearly for this egregious error. Who knew that these technology mavens would devise such user-unfriendly products? Physicians anticipated that the EHR interface would be comparable to that found in smartphones and tablets; sleek, easy-to-use, well-designed layouts using pleasant-to-read fonts. Dream on. It’s as though the developers lived on some remote Pacific island and had never handled a smartphone or a tablet.