Saturday, March 7, 2015

Failure of the Electronic Medical Records Mandate

     On Friday March 6, 2015, NPR had a piece on electronic medical records (EMR) as mandated under the Affordable Care Act.  The "hoped for" advantage of such systems would be the ability to share records, thereby enabling cross-referencing of symptoms and attempted remedies between practitioners and eliminating duplicated effort.  At great expense hospitals and medical practitioners have digitized their records, but the goal of sharing has not happened.  Thus far, it has been a waste of billions of dollars
     These EMR systems are unable to share information; thereby not enabling the industry to cross-reference and expedite. That totally defeats the potential gains through EMR.  The interviewee on NPR described how he checked into a “retirement” home and how they retyped into their computer system print-outs of his doctor’s computer system.

     This practice matches experiences we continue to have with hospitals.  As we moved from lab to lab within the same hospital, the first step always was for the nurse or tech to re-type everything into their computer. “Where is all this info going?” 
    The ability to share information was the primary objective for EMR.  But, for some reason, it seems no one implemented the necessary control to accomplish that goal.  Most just did what they were told.  Few had interest achieving purpose of this effort -- enhanced efficiency.  Why? 
     My best quess is three-fold: first, the practice of medicine remains “fee for service” and not a “fee for outcome”; second, a whole lot of people wanted Obamacare to fail and were going to do nothing to help it succeed; and third, legal risks were associated with errors and omissions in trusting another's data gathering. These challenges were not unknown, but why was there so little effort to address them?
    That mindset of “do what your told and don’t ask questions” seems inbred into our public sector.  Survival generally meant giving the appearance of working hard and “keeping your head down.”  For example, Bill Clinton as President once told his supporter how hard he was working for them.  That really seemed strange.  Why should anyone care "how hard" he was working? What was he  accomplishing?  
     Is this the difference between public and private sector work?  In the private sector "efficiency" often means survival. In the public sector "working hard" seems to be the goal.  As a business man and as an advocate trying to get involved in public programs, I have found this difference in focus borne out. Time and time again the goal in public work seemed to be policy development and publishing fancy multicolored brochures.  Seldom was much effort applied to gathering statistics and measurement of achievement. Few public programs implemented "follow-up" or tracked results against expected or promised goals.
     In the case of EMR, most hospitals and doctor’s offices have done a lot of "hard work" as mandated.  But with the continued “fee for service” practice and the absence of visibility of results , the goal of reducing medical costs is not likely anytime soon.

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