Government EHR Program: Unintended Consequences (continued)

Last week’s EMR Straight Talk, “Government EHR Program: Potentially Harmful Unintended Consequences,” seems to have struck a nerve with readers—based on the number, source, and intensity of the comments. The elevated level of concern is palpable. What I find rewarding is that blogs like EMR Straight Talk are creating a community of physicians who find support for their concerns—concerns that they might have thought were unique to themselves. Several of last week’s comments came from physicians who are not even on our mailing list, which means that their colleagues are sharing the blog, seeking to build support for their beliefs. Most of the comments were submitted by specialist physicians who are getting our message and beginning to speak up about why they do not consider the government’s EHR program relevant for their practices.

Those commenting identified several additional unintended consequences and voiced other concerns, including:

  • Dissatisfaction with templates and the utility of the notes they generate;
  • Failure of the government program to consider the needs of providers;
  • Effect of traditional EHRs on physician productivity;
  • Failure of physician organizations to speak out on behalf of their constituents; and
  • Difficulty of finding the right EHR for a practice.

An interesting comment came from Paul Roemer, who directed concerned readers to his post on, in which he suggests that the “meaningful use” dates will be pushed back. He maintains: “Washington created a $40 billion lottery and they are having trouble finding anyone able to purchase tickets.” His contention is that very few providers will be ready or able to take advantage of the incentives, including those who already have implemented a traditional, point-and-click EHR.

What do you think the government should do with its program that is clearly meeting significant and vocal resistance—particularly among specialists and other high-volume physicians? Submit your comments below, and let’s keep the conversation going.

11 thoughts on “Government EHR Program: Unintended Consequences (continued)

  1. I think we all should look at the process improvement literature before we deploy EMRs to all corners of the healthcare universe. One of the fundimental tenets of process improvement is to work out a process using low tech solutions before you invest in high tech solutions which can make the process harder to improve and can have a negative impact on productivity.

    What we are doing with EMRs is jumping to a high tech solution for many problems in healthcare before we work out a good low tech process for handling these problems.

    Any EMR, MUST be flexible or it will fail and it will frustrate its users. SRSsoft is very flexible and that is one of its endearing features.

    Evan, keep up the good fight.

    If you want to learn more about process improvement, I suggest you study Toyota Process Improvement. Watch how quickly Toyota recovers from the recent problems with their gas pedals and software applications. Their quick recovery can be confidently predicted because of their quality improvement culture and their “lean” process improvement methods.


    Jeffrey E. Epstein, MD

  2. One aspect of this whole process I have enjoyed is the giant physician yawn that has greeted all the government hoopla. Physicians who are tuned in at all are mostly here for the philosophical debate. Since the government can’t force us to take this money and buy EMR, we are at last liberated, in this one small instance, to do what is in the best interests of our patients and our practices (with no fear of incarceration).

  3. I hope this enlightens your readers.

    The Congress of the United States has been seduced by the dreams of HIT including the tall tales of the HIT vendors association trade group known as HIMSS.

    The Congress has been deceived by the charade called “certification” of EMR. It is provided by a group called “CCHIT” (pronounced see$hit), a “non profit” spawn of HIMSS, that gives the illusion that the equipment is safe and effective, when the certification process only involves checking boxes on a checklist of functions of the equipment.

    Obama gets his HIT advice from Glen Tullman, a fellow Chicagoan and CEO of Allscripts. Word has it that they played bball together in Chitown. He appoints N. DeParle to be health care reform czar. She was on the Board of Cerner when its products were associated with hospital meltdown and mayhem in the UK. HIMSS leaders have infiltrated “meaningful use” policy writing committees and are writing the laws. It goes on and on.

    This is a windfall for HIMSS and the HIT industry. It is an invasion of medical care by those who know nothing of what we do, These products are often an impediment to good care. Aten

  4. The introduction and support for EMRs is based upon a RAND report, funded by the manufacturers of the EMR programs, which highlight transparency and cost savings. The studies have been shown to be flawed, with underlying cherry picking of positive reviews to please the study funders. Reviews coming out now show that the programs do not save money but in fact cost more in dollars and physician time. The programs are inflexible, require every box to be checked prior to moving on, are difficult to navigate and in fact are the very model of “user unfriendly”.

    There are at least 17 companies that lead in this industry. All have proprietary programs which absolutely do not speak to each other. So data from one hospital cannot be transmitted to another (a highly touted reason for these systems) as the companies are jealous and protective of their own software in the hopes that theirs alone may be adopted as the national standard. The whole system is a boondoggle and should at least be seriously evaluated by an independent and not monetarily involved body – or perhaps it should all be scrapped.

  5. Given the current state of point and click EMR, would somebody please give me a good reason why we should:

    -Have a large capital expense
    -Have a large monthly upkeep

    For the joy of:

    -Longer hours
    -Loss of productivity

    I was one of the first in the world to use EMR, within the confines of the Department of Defense. While it certainly achieved accessability and allowed coordination, it sure slowed you down…even after becoming very facile with the system.

    If our 8 provider dermatology practice were to lose 20 percent productivity, even after “successful” implementation, that is the difference between staying alive and dying as a practice.

    The US government can and should get provider input before it entraps too many offices. My scepticism is well founded, despite the fact that I am quite techno savvy and truly eager to eventually dump paper charts.

  6. If and when the government experts come to their senses, they should encourage medical providers to use computers in ways that improve their care process in meaningful ways. They will not dance to the tune of IT industry self interest. For example, we know that there is value in collecting outcomes data, e-prescribing, and electronic ancillary ordering. Why not set the “certified bar” at a level that we all can believe in? The most elegant solutions are the simplest.

  7. Dr. Brown:

    I wish I agreed with you that physicians I have met the ARRA money with a collective yawn – I literally take calls and emails every week from existing and potential clients asking me “Where can I get my money?!” and I work with pediatricians, most of whom don’t even qualify (and, if they do, they get less $$). I have tried pointing out that a pediatrician – the lowest paid of all specialties – needs only to add 1 or 2 well visits a week to make more $$ than ARRA will provide (in the best circumstances), but that doesn’t matter to them.

    Sad, but true. ARRA questions are killing us.

  8. OK, let me qualify my statement and say that physicians of my acquaintance, many of whom are ophthalmologists, barely twitched. The greater “sad but true” is that doctors are such lousy businesspeople that they can’t calculate ROI. As a consultant [physician], I do get plenty of computer-based exam notes from the local pediatric practices and there is only one office that has a coherent and helpful format. So maybe one issue is that primary care physicians have not been on the receiving end of these documents to realize how confusing and frustrating EMR can be.

  9. I want to try on a few ideas on you concerning the EMR.

    In both Law and Banking professions the computer is used extensively to generate the information required to document the transaction between the institution and the client. They use this computerized data for quick reference when the client presents for a service. However, no one has ever proposed that they become totally paperless in the records of these transaction. There is always a hard copy !!

    Now what makes Medicine unique that it should become paperless ?

    It is certainly wonderful to have a digital copy on the computer for quick reference by Physicians, office personnel, Insurance filers, Office manager, Auditors, Lawyers, etc.

    However, if you consider the computer as only a “tool” in creating the patient’s medical record you immediately have a quick affordable solution to the EMR.

    By using the computer to generate the “True or Permanent Record” which is Paper, you gain all the advantages of the EMR without any of deficits. It is legible, not subject to electronic alterations or deletions, Requires no expensive Electronic Input Gadgets, No learning curve on how to create an EMR, Allows the physician to bring to the record increased information (i.e. Differential Diagnosis, Patient information, Drug Interaction).

    If you find one morning you have a computer glitch right in the middle of a busy
    Clinic, no problem, the paper record is still working fine and the computer generated hard copies can be accomplished at later date.

    The Hardware for the computer is already available at the level required by the various types of practices. Some solo practices could generate an EMR with only a
    simple desk top computer. Larger practices should be able to find computer power they require with minimal effort and cost. The soft ware can be purchase off the shelf. After all what is unique about typing someone’s Name, Address, Age, SS# etc
    I believe our documentation by Diagnosis is quick, complete, accurate and ready .i.e. Each diagnosis is formatted with ICD code, Etiology Check boxes,
    Symptoms and Signs-check boxes, Lab Studies
    Imagining, Management Protocals

    In “Going Paperless”We might be “ Throwing the Baby (i.e. Paper Record) out with the bath water.”
    I am almost certain that we will see many unintended consequences if we follow this path.
    The most elegant solutions are the simplest
    One of the fundimental tenets of process improvement is to work out a process using low tech solutions before you invest in high tech solutions which can make the process harder to improve and can have a negative impact on productivity.

    Have a large capital expense
- None.

    Have a large monthly upkeep -None.

  10. Nice post. Seem true on most accounts but I also think that today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.

    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.

    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.

    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment.

    Also the introduction of REC’s through the HITECH act is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.

    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the ‘safe vendor challenge’ as discussed by many critics.

  11. Dr. Epstein is right on when he suggests that we need to improve or strealine our current operations before and during implementation of an EMR system. It has been my experience that if you don’t streamline or improve now then all you will do is potentially pass the same problems and issues onto the next new process. That’s why I advocate that NOW is the time to reengineer all processes. An EMR system is not going to solve many inefficiencies existing now in busy physician practices. It will only compound the problems and create frustration with the support/technical staff, physicians and patients. I can guarantee you that if the support/technical staff and physicians are negative and frustrated, it will be readily recognized by the patients; who are the ones that all of us are trying to provide quality patient care. Question: Is all of this a “smoke screen” for socialized medicine? Is there a bigger plan in mind that this is a plan to fail which will move us closer to that realization?

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