The HIT Emperor Has Never Had Any Clothes

John Irvine / 13 Dec, 16 /

The HIT Emperor Has Never Had Any Clothes

Over the last several months, I have worked to make the following the official policy of the Massachusetts Medical Society:

That the MMS will advocate to our State and Federal Representatives to end all legal constraints and financial inducements arising from the use or non-use of Office of National Coordinator (ONC) Certified EHR Technology.

That the MMS will encourage our Massachusetts Federal Legislators to introduce legislation to end the ONC’s EHR certification program, and will ask the President of the United States to immediately request that such legislation be introduced.

While the MMS’s Committee on Information Technology voted unanimously to support the above proposal, the MMS rejected the above and choose instead to make the following official MMS policy:

That the MMS will work with appropriate government entities to foster EHR innovation, affordability, and functionality by modifying the certification process for EHRs to improve patient care.

Without a doubt, ONC’s EHR certification program has stifled innovation in EHRs in particular and in health information technology (HIT) in general. In addition, the data accumulated to date has shown these ONC’s Certified EHRs have failed to have a meaningful impact on either the cost or quality of healthcare.

The 6 December 2016 issue of Annals of Internal Medicine has an article which shows that for every hour a physician is involved with direct patient care results in an additional 2 hours of EHR work (in the office/clinic) and then more EHR work from home. No wonder MDs are so dissatisfied with the practice of medicine. The accompanying editorial (Ann Intern Med. 2016;165:818-819) concludes “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system ”

I find it unfathomable that neither the MMS, AMA, ACP have tried to forcefully end MU/MACRA/Certified EHR programs. To date, these organizations have been complicit in allowing this programs to continue. While I fully understand it would take an act of Congress to end these programs, these programs have seriously crippled our ability to take care of our patients and, more significantly, have stifled EHR innovation. In addition, these programs have relegated the physicians from the prime mover in the health care world to the role of a vendor and enabled the healthcare system to be taken over by the politicians, Federal bureaucrats, EHR geeks, EHR vendors, large medical institutions and insurance companies. While physicians can rightfully claim that their first priority is to the care of their patients, none of these entities can make a similar claim. Most injurious to the entire healthcare system, in my opinion, is the fact that the large EHR vendors and the ONC now decide how physicians actually implement the practice of medicine in their own exam rooms.

While all this was happening, the organizations which supposedly represent the interests of physicians sat by and ignored our “Prime Directive” (due no harm.) They allowed ONC to create and evolve their programs, while providing ONC with “helpful” suggestions, even though there was no a priori evidence that these programs would work as intended. And once the evidence began to accumulate that these programs did not achieve the desired outcome (lower healthcare cost/higher healthcare quality), these organizations repeatedly ignored the data, they continued to believe the HIT geeks who told them “after we get over the next HIT hurdle, everything will get better” and they trembled when the HIT geeks called them Luddites for questioning the proposition that “more HIT is better.”

In my opinion, the solution to the cost half of our healthcare problem does not reside in health information technology. It will require a shift of resources away from treating chronic diseases in favor of preventing those diseases with better education, better/safer jobs, better nutrition, more accessible healthcare. And there is data to support this proposition. And there are countries which have already implemented such a system.  Unfortunately, neither our society nor our medical professions appear to be ready to accept this fact and begin doing the hard work that this solution will require.

And it still remains an open question whether more HIT will solve the “qualify” half of our healthcare problem. The data to date is not very encouraging. Yet despite this fact, HIT geeks still tell us that “more HIT is better.” The current “next HIT hurdle” is “interoperability.” As we all “know,” once all EHRs can pull/send data on demand to any other EHR, all of the healthcare system’s problems will be solved. At best, I am skeptical.

On November 30th, the American Hospital Association asked the President-elect to end Meaningful Use.  I believe the MMS, AMA, ACP and all the major medical societies should prominently and proudly support that effort.

Hayward Zwerling, M.D., FACP

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