A recent article from Fortune chronicles a story of hope, innovation, adoption, desperate spending, and abandonment. The government promoted EHR adoption with a goal of bringing healthcare technology into the current century, but it has yet to truly realize that ambitious undertaking.
‘Death By a Thousand Clicks: Where Electronic Health Records Went Wrong’, by Erika Fry and Fred Schulte, is an article that will open a lot of eyes. However, TrekIT Health has not just been seeing, but experiencing this reality all along.
Migrating clinical data and patient records to a centralized system is a great concept, in theory. Increased legibility, access and the portability of records are all process improvements we have been desperately chasing. However, poor design and years of disjointed implementation have crippled what progress has been made. It is abundantly clear: we need an EHR intervention.
In the early 2000s, the federal government incentivized adoption of EHRs, with a total investment of $36 billion. Despite funneling dollars into this well-intended but mis-managed legislation, the program has failed to provide streamlined care while enabling interoperability.
The fallacy of EHRs is that they were originally devised as a digital medical billing platform, as the Fortune article confirms. This is a necessary part of medical records — but should not be the primary focus. Other meaningful use milestones were designed by large vendors, who were focused on “box checking” in order to qualify for a reimbursement instead of what was truly necessary to improve clinical care. This was a clear disadvantage for clinicians, who had different expectations.
As a result, we are left with systems that on paper say they do one thing, but in reality do something completely different, In fact, these systems have introduced a whole slew of errors. Glen Falls Hospital in New York state recently lost $38 million in revenue because of a faulty EHR system. This however, is just the tip of the iceberg – due to gag and hold harmless clauses, we don’t even know the full extent to how EHR designs have, and continue to, lead to medical errors.
The reality is that EHRs are not going anywhere (it wouldn’t be prudent to get rid of them, either). What we need now is to pursue collaborative answers, pushing forward with the initial direction EHRs have taken us. It won’t be easy, but by building a cohesive ecosystem of tools that unlock the data currently held hostage in EHRs, we cut through the wasteful applications and find clear, common ground.
The first iteration of the technology revolution in healthcare turned believers into skeptics and skeptics into, well, even bigger skeptics. Although there is great discontent because of this, we believe there are huge leaps being made in how we can take our information systems to the next level and finally start to realize our original vision of a technology-empowered healthcare industry.
When we built TrekIT Health’s proprietary platform, we listened closely to the doctors and clinical professionals who deal with these issues every day. I was one of those prospective users who decided to design a product more suitable for the current era of patient care. We need more of this close collaboration between users and developers to build products that can truly meet modern demands. Instead of each EHR vendor limiting their customers’ ability to collaborate and learn from each other’s experiences, we should be working together to design better, open systems that communicate with one another and anticipate errors or lapses.
As the article points out, computer error can be a bigger threat than human error. Software glitches and faulty data have been attributed to missed diagnosis and patient deaths. Certainly not the outcome innovators and government advocates envisioned twenty years ago. And yet, EHR vendors seem to throw their hands up and say “it’s not our fault.”
This must change immediately. We are all working to provide safer, better care for patients and our loved ones.
After seeing the Fortune reporting, Food and Drug Administration (FDA) Commissioner Scott Gottlieb spoke out in favor of tighter regulations and attested to the potential vulnerabilities EHRs have to hackers. His call for more oversight was a step in the right direction, although there’s no one-size-fits-all solution, since current regulations only apply to medical devices, a separate category. This strategy needs to begin in the early development and design stages and continue through technology validation. A more rigid set of guiding principles needs to be agreed upon by leaders in the industry.
TrekIT Health came to the conclusion that technology is finally sophisticated enough to handle real-time requests, process large troves of data at high speeds, and maintain continuous communication with tablet and app programs. Something that was not possible twenty years ago.
As a company that has a clinical clientele, we are constantly hearing about how EHRs are not user friendly or designed to serve a goal of creating process improvements and allowing for a better operation. This complexity trickles down to the patient — the ultimate victim of faulty or inadequate technology. By retrofitting EHRs into a tool for accessing actionable data insights and improving communications, clinicians and patients are done a disservice.
What’s next? We want to hear more from the clinical professionals who have reservations with this current generation of legacy EHRs. The government needs to act quickly on a task force for intervention. We need leaders of health organizations, activist groups, and technologists to unite in an effort to set an agenda and present new solutions for our self-inflicted crisis.
Current systems are flawed and outdated. We need new software, built with the end user in mind, to enable the way EHRs serve patients and clinical professionals.
At TrekIT Health, our technology has been in the hands of clinical professionals for more than three years. The goal we have in mind is a clinical experience that is enjoyable and focused on why we first joined the medical field — to help people. Reporting and other administrative tasks that are necessary but not part of clinical care, should be easily pulled from systems out of work we naturally do to take care of patients, instead of forcing us to go out of the way to check specific boxes. Unburdening clinicians from this type of non-clinical work and freeing them up for patient care will help reduce exhaustion and burnout.
My professional research, at the intersection of technology and clinical workflow, suggests these improvements are achievable.
But where do you stand on the subject? It’s our job to ask questions. Tell us what you think and what we should be doing as a collective industry. Open dialogue is key to finding common ground and planting the seeds of change. Tweet us @TrekITHealth or email me at subha@trekit.health.