The HITECH Act is a frightening diagnosis for doctors already fearful of the Obamacare unknown. It is a mandate that requires physicians to transition to computerized versions of patients' paper charts by 2015, according to healthit.gov, and is another unfortunate arm of the Affordable Care Act. While some applaud this Electronic Health Records implementation process as proof healthcare is moving into the 21st century, many doctors are wary of having to rely solely on computers to access their patients’ records. I’ve outlined just a few of their concerns.
The LOWS of the HITECH Act
Adapting to Technology
A recent report from the vendor research firm KLAS Enterprises ranked six EHR vendors to determine their patient portal capabilities. A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information. Athenahealth was the top performer and only vendor to adequately support all five meaningful criteria. Epic took second place, followed by Allscripts, Cerner, eClinicalWorks and Intuit Health.
Allscripts, the vendor apparently good enough for third place, is currently being sued by several physicians for selling them faulty healthcare information technology. The details: Allscripts sold one of their software products, called “MyWay” to 5,000 physicians for the price of $40,000 per user. The product turned out to be defective. Then, instead of trying to fix the product, Allscripts removed it from the market, leaving the doctors to deal with the damages. Allan Joseph, a lead counsel for the plaintiffs in the Allscripts Class Action, outlined some of the technological challenges his clients are facing in regards to The HITECH Act in an email to Townhall:
“Depending on the product, there is a massive undertaking first to acquire the hardware, and then to install the software and the volumes of data required to operate the software. Then, the operations of the software needs to be implemented. There is a huge learning curve. The practitioners and their staff need to actually learn how to use the software. Most of the products are not intuitively simple to use (they are not, despite the marketing, plug-and-play); there is a great deal of “interaction” between the data and the operations. From charting to billing and everything in between, the learning curve is crushing in terms of time expended. Real and bona fide training is critical to the operational success. And, the manufacturer must be honest and upfront to the practitioner about the commitment that is truly required to make this product work.”
“There has been a tremendous loss of productivity due to the training and learning curve associated with the implementation of the software. In many instances, practices have been forced to endure huge losses due to billing errors generated by a software malfunction. We have heard many instances where administrative staff simply quit due to the aggravation of the implementation and operational difficulties of certain manufactures. Many practices, even with the receipt of federal subsidies, have suffered huge losses.”
Rosemarie Nelson, a Medical Group Management Association consultant based in Syracuse, N.Y., agreed that doctors receive little training, partly because they don't want to take the time out of their busy work schedules. She provided additional insight to Townhall via email:
“Doctors are not receiving the right amount of training for a couple of reasons. When negotiating contracts for systems both parties (the vendor and the customer) often reduce the training time to save money. Doctors do not often give up patient hours and/or personal time to participate actively in training as a team with their clinical support staff.”
“Doctors are most concerned with how their day will change, just like everyone else adopting a new process or undergoing change. Even if we are not happy with the status quo, it is difficult to change the status quo.”
Technology breaks. Anyone who’s tried to download a file on their PC understands this unfortunate reality. Now, imagine the tech troubles in a doctor’s office. If these physicians do manage to figure out the new electronic-based systems, they are suddenly having to deal with disappearing data and computer glitches that have caused complications, a few that have even tragically led to deaths.
The American College of Emergency Physicians has found that poorly designed EHR systems in use at hospital emergency departments are leading to “communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue.”
Bloomberg.com lists a number of other common errors:
Dangerous doses of drugs have been given because of confusing drop-down menus; patients have undergone unnecessary surgeries because their electronic records displayed incorrect information; and computer-network delays in sending medical images have resulted in serious injury or death, according to a study published in 2011 based on reports submitted to the U.S. Food and Drug Administration.
According to a study published in December by the Pennsylvania Patient Safety Authority, the number of reports about medical errors associated with electronic records is growing. Of 3,099 incidents reported over an eight-year period, 1,142 were filed in 2011, more than double the number in 2010.
In addition to the technological issues, the hefty price tag of Obamacare’s electronic records mandate is also cause for concern.
The average physician would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive.
Doctors like Eugene Sussman are recognizing these costs may have dire consequences:
The costs “are the biggest holdback nationwide,” said Sussman, 64. “Doctors who are my age, in their early 60s, maybe will retire out. They may think, ‘I don’t need this bother; it’s going to cost more money and cost more time.’ ”
A final repercussion to consider is how computerized records will affect the cherished doctor-patient relationship. Perhaps Dr. Richard Reece, from the MIT Technology Review, said it best,
The computer is oversold as a tool to improve health care, implement reform, cut costs, and empower patients. The reasons are obvious to anyone who treats patients. You cannot look a computer in the eye. You cannot read its body language. You cannot talk to an algorithm. You cannot sympathize or empathize with it.
Reece is right to lament the loss of the all-important doctor-patient relationship. This bond, which helps to build trust and peace of mind, is being compromised by emotionless computers.
Between the faulty and frustrating technology, the crippling costs and the widened divide between doctor and patient that can result from the computerization of health records, the resounding message is clear: When it comes to a patient’s history, nothing is so secure as a hard copy.