When the HITECH Act was passed in 2009, many cheered. Healthcare was about to change. At long last, talk would be backed up with billions of dollars. Doctors and other providers finally would adopt electronic records. Electronic networks would enable them to access a patient’s complete medical record at the point of care. Care quality would go up, costs down. Pain and suffering from medical mistakes would be reduced if not eliminated. Patients would have access to their records, too, and receive better care. Their absenteeism from work would go down. Their productivity would go up. The total cost of healthcare would go down. Very lofty expectations, indeed.
They also cheered for practical reasons. An early McKinsey study, a later study from RAND Corporation and a newly released study from the Institute of Medicine, estimate that the annual financial cost of medical mistakes — about a third of which McKinsey estimates result from doctors not having access to patients’ records — range between $300 billion and $1 trillion. So, by giving docs access to patient records, we should be able to cut costs by some $100 billion to $330 billion! What could be simpler?
It’s three years later and eight since the Office of the National Coordinator (ONC) was established. Where are we? Are we better off than we were three years ago? Have we met any of our expectations?
On the surface, we’ve made considerable progress. Since 2008, the number of doctors who have adopted or signed up for electronic medical record (EMR) systems has increased from 17% to 34%, and hospitals from 12% to 40%. Through October 2012 ONC has dispensed more than $9.2 billion subsidizing these adoptions. Untold millions or perhaps billions have been spent by EMR vendors getting their systems “certified” and providers installing and learning how to use them.
But are these the right metrics to measure success? Has this program met our expectations? Can providers access a patient’s complete medical record when they need to? Can they easily coordinate patient care? Have we materially reduced medical mistakes and the pain, suffering and costs that accompany them? How much of the annual $100 billion to $330 billion in potential savings have we realized?
The answers are bleak. No. Most providers can’t access their patient’s records from other providers or more easily coordinate care. For $9.2. billion, we’ve created larger, more sophisticated electronic care provider silos but most of the networks, health information exchanges (HIEs) intended to link them together, don’t work. Very few doctors or hospitals can access a patient’s records outside their own networks. And instead of demanding that a patient’s complete record be available to their care providers, including copies of complete progress notes, we pat ourselves on the back that a patient, using an application called Blue Button, can print out summarized records from one provider and give them to another. Better than nothing? Yes. What’s needed and was expected? No.
And no. We probably have not materially reduced medical errors. It’s hard to prove a negative. But if the cost of healthcare is a measure of mistake reduction, the answer is no. Costs have continued to go up, not down — though the rate of increase has flattened.
And no, again. To the extent that access to patient records enables providers to avoid mistakes, we’ve probably not reduced the pain and suffering that accompany medical mistakes. All kinds of anecdotal evidence support this conclusion. In two high profile examples, both Dr. Farzad Mostashari, the National Coordinator of ONC, and Dr. John Halamka, chair of the ONC–sponsored HIT Standards Committee, recently reported how their mothers suffered serious mistakes in treatment that could have been avoided if their providers had had access to their mothers’ complete medical records. It’s safe to assume millions more have suffered unnecessarily as well.
And no, again. Our inability to provide access to patient records probably translates into little–to–no reduction in our targeted $100 billion to $330 billion in unnecessary costs.
Given these poor results, where’s our sense of urgency, anger, and outrage? Why is no one demanding better results, now? We have spent years and billions but little to show for it!
We casually accept that it will take a few more years at least to resolve these issues — by 2015 if we’re lucky, even though a three year delay will cost a staggering $300 billion to $1 trillion! And what about the pain individuals are suffering every day, the unnecessary deaths, the lost productivity? We should be clamoring for explanations, new approaches, and results now, but that’s not happening. The only real outcry has come from physicians and hospitals who are being pressed against their will to adopt EMRs — but no one appears to be listening.
In today’s political climate, some will try to turn these shortcomings into a political issue. It is not. It has nothing to do with Obamacare or insurance exchanges or who is covered by Medicare or Medicaid or Republicans versus Democrats. The closest it comes to being political is that it does seriously impact our federal budget. Saving hundreds of billions of dollars per year by reducing healthcare costs now rather than years from now would go a long way toward cutting our deficit and stimulating our economy. Think of it this way. Over ten years we could save an even more staggering $1 trillion to $3.3 trillion!
The real issue here is to define the problem correctly. Our narrowly–focused, single–minded approach has taken us down the wrong path. It has mistakenly combined two critical parts of the healthcare IT problem that can and should be resolved separately. In healthcare, delay translates into both pain and money, and our approach is costing us dearly.
The two issues are, first, how patient medical records should be kept. Second, how we get them into the hands of providers at the point of care.
I strongly support the use of electronic records and hope every doctor eventually will adopt them. But I also understand that 66% of physicians and 60% of hospitals apparently still find today’s EMR systems and Meaningful Use requirements problematic. They haven’t adopted them even though they would receive substantial government subsidies for doing so, and face severe financial penalties for not doing so by 2015.
It’s clear that the solution to provider–adoption of EMRs is complex, will take more time, and probably require the development of different types of EMRs. But this need not stymie or delay solving our second issue, namely, how to ensure that a patient’s complete medical record is available at the point of care.
Health Record Corporations’s MedKaz® solves this second problem — now. It already exists and is available today. It employs established technology, accommodates patient records in both paper and disparate electronic formats, is easy to use and affordable, and doesn’t require government subsidies.
If we embrace this or other new solutions now, we can begin to meet our expectations now. We’ll be able to reduce medical mistakes, provide better care, and reduce the cost of care — even though we will not yet have solved the problem of EMR adoption!
All we have to do is open our minds and broaden our approach. First, we must adopt a sense of urgency and stop tolerating delays. Delays permit great pain to continue for millions, and cost billions. Second, we must separate the problems and solve them as quickly as possible. Universal EMR adoption probably will take years, but we can ensure that patient records are available to providers now.
Overcoming today’s momentum will be very difficult. It will take a groundswell of anger and outrage to change direction. Ready to speak up?