Guest Blog: Health Technology – Finding dream solutions from nightmare scenarios

Dr. Jan Gurley is a board-certified internist physician with an extensive health and science background. Her health writing has appeared in Salon, The San Francisco Chronicle, BlogHer, KevinMD and SFGate’s City Brights, and her research has appeared in academic publication like the New England Journal of Medicine. Dr. Gurley is also an HTF Board Director.

Nobody doubts the promise of health technology, whether it is in devices, treatments, process improvements, big data and data mining or other potential avenues. This promise is the reason for the Health Technology Forum and why all of us are so involved and passionate about these issues.

But not every avenue of technology has led to immediate success. This is least contentious in Electronic Health Records or EHR. Touted for years as the savior of healthcare systems and a panacea for rising costs and ever-increasing requirements around privacy, record keeping and information tracking, it has instead limped its way to ahead of older, more analog systems.

For over a decade, medical technologists have promised that EHRs will revolutionize health care (the Office of the National Coordinator for Health Information Technology was created under President George W. Bush’s Administration). The Affordable Care Act has hastened their implementation. The idea is that they’ll reduce paperwork and administrative costs. But as more providers jump onboard, the negative impacts seem to be growing.

Is this assertion really true?  Let’s take a look. An NYT article pointed out additional productivity and patient safety issues raised about electronic medical records at other locations, even from health care establishments as impressive as the Mayo Clinic.

A recent article in STAT pointed out that doctor burnout may well be because the healthcare system is a complicated mess.

A group of doctors in Contra Costa County set up a Doccupy movement as a protest against enforced use of EHR systems.

A survey of doctors by AmericanEHR Partners revealed the following:

• On average, survey respondents had been using their EHRs more than three years at the time of completing the EHR satisfaction survey.
• Satisfaction and usability ratings dropped. This held true regardless of practice size, specialty type and across multiple vendors.
• In 2012, 39% of clinicians would not recommend their EHR to a colleague.
• Dissatisfaction with ease of use was reported among 37% of respondents in 2012, compared with 23% in 2010.
• And 32% of respondents had not returned to normal productivity levels in 2012 compared to 20% in 2010.

EHRs are supposed to streamline health care and reduce errors. But Kaiser Health News reported on a JAMA-published study that found “nearly 30 percent of doctors responding to a survey say they have failed to notice important test results because of the deluge of information available with electronic records.”

Imagine if we went back in time, when EHRs were initially proposed. What if sponsors said at the time that these systems would decrease productivity for one-third of doctors permanently, and make one third of doctors more error-prone? And there’s the cost. The Contra Costa Epic EHR system cost $45 million dollars. Trade publication FierceHealthIT notes, “One Health Affairs study put the cost for an average five-physician practice at $162,000 for implementation, plus $85,500 in maintenance expenses during the first year alone. Meanwhile, clinical and nonclinical staff spent 134 hours per person, on average, to prepare for use of the record system in clinical encounters, according to the study. The cost for a physician practice sounds like a bargain when compared to a large, complex system. For Detroit’s Henry Ford Health System, the price tag was a whopping $356 million, an outlay it said was a major factor in a 15 percent decrease in net income in 2012.”

Consider the health care efficiency math. The $45 million for Epic in Contra Costa County would pay an annual $200,000 salary for 225 primary care or pediatric doctors. The $356 million price tag in Detroit clocks in at 1,780 full-time primary care and pediatric doctors for a year – and there are only 1,003 total doctors of all specialties practicing in Detroit!

What lessons can be learned by health technologists? The wrong lesson is that technology is not a good partner to health. That horrendous complexity pointed out in STAT can be seen as opportunity. The right lesson is to plan, to study the market, to fit solutions carefully against known problems. But it is also, perhaps counterintuitively, to get bigger, to get bolder, to get better. The problems in healthcare are enormous and growing. That means the same is true of the opportunities. So dream big. Then take those dreams and apply them carefully in the real world.