Why haven’t EHRs made us healthier?
March 6, 2013 in Medical Technology
Almost 20 years ago close to 4,000 people from 200 companies gathered in San Diego for a conference to discuss the future of healthcare information technology. This was before the Web. This was back when computers in physicians’ offices, to the extent they were present at all, were used only for scheduling and billing patients. Paper charts bulged out of huge filing cabinets.
It was one of the first big conferences held by the Healthcare Information and Management Systems Society (HIMSS). I was among a grab bag of physicians, technologists, visionaries, engineers and entrepreneurs who shared one idealistic goal: to use information systems and technology to fundamentally change health care.
We didn’t just want to upgrade those old systems. We imagined a future that looked a lot like what we were being promised throughout the economy as it sped into the Internet era. Computers would enable improvements in the practice of medicine—and make it safer, higher quality, more affordable and more efficient—all at the same time. We wanted people to be healthier.
Not long after that conference, a group of us began building a company called Allscripts that initially focused on electronic prescriptions. Old jokes about illegible doctor handwriting belied serious safety issues. The Institute of Medicine calculated that 7,000 Americans were dying each year from preventable paper prescription errors.
In rural New Hampshire, an innovative physician named Azar Korbey transmitted the first fully electronic prescription using our system. Today, according to industry source SureScripts, about 600 million prescriptions out of 1.5 billion in the U.S. are written electronically. That’s substantial progress. Electronic prescribing is saving lives. But there is more to do.
The next phase was electronic health records. Allscripts and rivals like Cerner and Epic found ways to automate a complicated clinical encounter. It became a national goal to make all physician practices and hospitals digital.
This didn’t seem out of reach. After all, computer visionaries like Bill Gates and Michael Dell talked about how computers would change everything. But we (and they) soon realized that putting PCs on every desk was only the first step in the information revolution. It wasn’t until we connected those computers together using the Internet and developed “apps” that everything changed about the way we work and play. Remember Amara’s Law: “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.”
Two decades later the question is being asked: Did our industry succeed in doing what we said we would do?
The process of getting from zero to nearly half a million physicians using electronic health records systems has been arduous. To paraphrase Churchill, this is not the end. It is not even the beginning of the end. But is it, perhaps, the end of the beginning of the electronic health revolution.
We’ve seen people knock the value of our investments in these systems, criticize the government’s stimulus, and question the return on investment. David Kibbe, a physician and technology advisor to the American Academy of Family Physicians, wrote in an open letter to President Obama that electronic health records are “notoriously expensive” and “difficult to implement.” Arguing against subsidies, Kibbe wrote: “Nor is there conclusive evidence that the use of EHRs improves patient care quality.”