A health information technology standards pioneer and physician is questioning whether encouraging doctors to use e-health records is really a good idea.
In an article for the March/April issue of the Journal of the American Medical Informatics Association, Dr. Donald Simborg wrote that the government’s policy of promoting EHR adoption, “if not modified, may backfire” and fail to achieve its goals of enhancing the quality of health care while holding costs down.
“The current policy of promoting adoption of EHRs requires some rethinking,” Simborg wrote.
Simborg, a founder of the standards organization HL7, noted that most of the financial rewards of using EHRs accrue to those who pay for health care, such as insurers and employers, although doctors are expected to pay for the systems. Further, doctors must reorganize their offices and change their working habits when they begin using EHRs.
As a result, EHR vendors have had to rely on other features to sell doctors on the merits of their products, Simborg wrote, adding: “It is these other features which have the consequence of undermining the fundamental value proposition of EHRs.”
First, doctors who use EHRs tend to code patent visits and treatments at higher levels than before, resulting in higher revenues for the doctor. “It is not known whether this increase represents a correction of previous under-coding…as some say, or a form of…code creep,” the article states.
Second, doctors quickly learn to use pull-down menus, templates and cut-and-paste techniques to document their work rather than typing out new notes for each patient visit. Simborg wrote that although he cannot prove that such documentation is less accurate than when a doctor dictates notes, he pointed to some early evidence and expressed strong doubts.
“Even though there are other quality benefits of these systems,” he wrote, “this cannot justify the acceptance of degraded and potentially misleading documentation.”
Faulty documentation can sometimes rise to the level of fraud when doctors send in inflated bills for payment, Simborg added. Although there has been discussion of building anti-fraud features into EHRs, there are no industry standards or requirements yet.
He recommended a new focus “on correcting the problems in EHRs and, more importantly, on the financial environment which underlies those problems.” The Health and Human Services Department, its American Health Information Community advisory panel, the national coordinator for health IT and the rest of the health IT community should promote “EHRs that enhance quality, cost reduction and fraud management, even at the risk of delaying adoption,” Simborg wrote.
From the battlefield to the home front: Managing medical data
Government Health IT presents Col. Claude Hines Jr., program manager for the Defense Health Information Management System, in this recent InSight eSeminar. Col. Hines discusses the health information technology and tactical challenges faced by the military medical community in Iraq, Afghanistan and other areas of conflict. In doing so, he describes the current information technology solutions for transferring clinical data between battlefield care givers to health care personnel at military treatment facilities worldwide.
