Electronic Health Records considered harmful

Wow. Authorities finally figured what doctors have been saying for years. EHRs suck time and attention. The primary-care doctor who sees me works for a gigantic health-care conglomerate. He uses his own money to hire young people to sit and type mandatory gibberish into EPIC while he examines patients like me.  Everybody knows the purpose of EPIC is CYA: to justify billing.

Siddhartha Mukherjee pointed this out in a recent article. He summed up the state of US health care: “The numbers in the bean counter’s ledger are now body counts in a morgue.”

The governor of New York issued an executive order suspending regulations about keeping electronic health records up to date. Those regulations require physicians and other health care professionals to make sure they update their records.

The state government summarized the order like this:

Health care providers are relieved of recordkeeping requirements to the extent necessary for health care providers to perform tasks as may be necessary to respond to the COVID-19 outbreak, including maintenance of medical records that accurately reflect the evaluation and treatment of patients, or requirements to assign diagnostic codes or to create or maintain other records for billing purposes. Any person acting reasonably and in good faith shall be afforded absolute immunity from liability for any failure to comply with any recordkeeping requirement.

Read this paragraph carefully. Health care professionals need immunity from liability to “perform tasks as may be necessary.”  Immunity!  In the present emergency, they don’t have to spend time looking up the official ICD-10 diagnostic code for each problem their patients present.  They can actually treat patients.

Whoever wrote those emergency regulations for New York State clearly understands the situation.

Maybe the present public-health disaster will finally make people realize that electronic health records are the tail that’s wagging the dog.

I suppose it’s too much to ask that the EPIC company will take all this to heart. They could use their clout on CMS and private payers to demand that the billing and payment process be streamlined, so EHRs like mine aren’t quite so full of billing boilerplate.

What I want is this: EHRs must serve patients, health-care professionals, and the disciplines of medicine, not the other way around. Of course doctors and hospitals should keep records, but they should be about patient health, not payers and their ICD-10 codes. Dr. Mukherjee put it this way:

Finally, we need to acknowledge that our E.M.R. systems are worse than an infuriating time sink; in times of crisis, they actively obstruct patient care. We should reimagine the continuous medical record as its founders first envisaged it: as an open, searchable library of a patient’s medical life. Think of it as a kind of intranet: flexible, programmable, easy to use. Right now, its potential as a resource is blocked, not least by the owners of the proprietary software, who maintain it as a closed system, and by complex rules and regulations designed to protect patient privacy. It should be a simple task to encrypt or remove a patient’s identifying details while enlisting his or her medical information for the common good. A storm-forecasting system that warns us after the storm has passed is useless. What we want is an E.M.R. system that’s versatile enough to serve as a tool for everyday use but also as a research application during a crisis, identifying techniques that improve medical outcomes, and disseminating that information to physicians across the country in real time.

It’s not just EPIC who blocks the potential of the records. It’s the hospitals and the payers too. Open records serve only the needs of patients, their caregivers and the science of medicine. They don’t serve institutions.  (Note: by “open” I don’t mean insecure and vulnerable to cybercreeps. I mean usable by the right people.) Why, with open records patients could evaluate the quality of their care! If they didn’t like it they could find another caregiver! The institutions can’t have that.

I hate to be cynical about this, but once the present pandemic subsides, I guess health care people will go back to Hauling up the Data on the Xerox Line (a Stan Rogers song).

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