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Monday, October 26, 2015

Why Doctors Are Still Faxing

Electronic work hasn't replaced paperwork

An exposé in Mother Jones provides a fascinating look at how President Obama’s “common sense” plan to digitalize medical records turned into an expensive fiasco.

After nearly $30 billion in stimulus money to subsidize electronic health records (EHR), many doctors think using computer software is more hassle than it’s worth, and most are still faxing and mailing physical paper records.

Something is deeply wrong here.

It turns out that having digital copies of records is only useful if they can be sent to other machines and read by them. And that is precisely what the stimulus failed to accomplish.

Instead, it spawned a mess of incompatible systems throughout the medical industry that couldn’t easily communicate with each other. The government’s digital health records plan created an electronic Tower of Babel in healthcare. 

When Congress passed the $840 billion stimulus package, it allotted $30 billion for hospitals and medical providers to digitize their records via the Health Information Technology for Economic and Clinical Health (HITECH) Act. So far, the government has forked over $28 billion to doctors and hospitals to install EHR systems.
Despite the acronym, the HITECH Act wasn’t particularly tech-forward. When it took effect, storing files in the cloud seemed like uncharted territory for most physicians, who worried about privacy breaches. Hospitals and doctors defaulted to hosting their own files on local servers. …
In terms of bringing digital records to practices across the country, the HITECH Act has unquestionably succeeded: The percentage of US hospitals using digital rec­ords skyrocketed from 9.4 to 75.5 percent between 2008 and 2014.
But the HITECH Act didn’t prioritize “interoperability” — the ability to transfer a medical file from one hospital to another. Unless programmers ensure that their system properly integrates with another, a doctor’s computer might spit out something akin to emoticons when queried for key test results. …
“By subsidizing ‘where the industry is’ rather than where it needed to go,” [RAND Corporation] said, the government propped up an [electronic health records] market “that did not have the level of connectivity envisioned by the authors of the HITECH Act.”

Mother Jones singles out health software contractor Epic as a particular roadblock to progress, with crony connections to Obama administration that made it uniquely situated to scoop up the subsidies, but not necessarily to serve clients and patients. 

Epic was shovel ready for this stimulus windfall. Faulkner’s company was one of the few software vendors back then offering an all-in-one package covering a hospital’s recordkeeping needs. …
Meanwhile, Faulkner — Epic’s CEO and a major Democratic donor — landed a spot in 2009 on the Obama administration’s Health IT Policy Committee, which helped shape the regulations guiding health care software and pushed to rapidly implement EHR in hospitals without first figuring out how to trade records between different systems.
And since last year, Epic has paid lobbyist Bradford Card, the brother of George W. Bush’s former chief of staff, more than $130,000 to convince members of Congress that the company plays well with others.

The results of this scheme for healthcare are abysmal. EHR companies charge fees to connect each one of their record systems to other companies’, and then charge them fees for transferring information about every patient, every year.

In addition, the government’s National Coordinator for Health IT believes that the companies are engaging in “information blocking” in order to “control referrals and enhance their market dominance.”

Fax, by contrast, is still free. And that is what hospitals and doctors are using.

The upshot is that according to a government report released in August, only 56 percent of hospitals had received electronic records from other practices in the past year — and just 40 percent of those had successfully merged the information into their own databases.
A recent study by the American Medical Association and the online network AmericanEHR Partners found that 43 percent of physicians thought their software actually made their jobs more difficult. Doctors are investing the time to input data, but their offices are still having to fax and mail records like they did a decade ago.
Less than 10 percent of hospitals say they’ve been able to trade records entirely through their digital systems.

Eventually, kicking and screaming, the healthcare records industry will be dragged into the 21st century, but the government’s crony regulations and subsidies haven’t helped. And worse still, doctors’ biggest paperwork burdens no longer come from patient records but from Obamacare — in some cases doubling doctors’ administrative workloads. The Miami Herald reports,

For many physicians, the so-called Obamacare cards also mean new challenges — consumer misinformation, increased paperwork, heavier patients loads and the worry of unreliable reimbursements and payments. … 
There’s the extra paperwork that must be completed, from charts for new ACA patients to quality of care self assessments.
[Dr.] Wollschlaeger said administrative tasks have become about 40 percent of his workload, up from 20 percent before the ACA. On Monday, he finished seeing patients and started paperwork at 6 p.m., a time he would have used for that modern-day rarity, house calls.
“Something has to give,” Wollschlaeger said. “More paperwork means less patient care.”

And that’s true whether or not there’s any paper in that paperwork. 

  • Daniel Bier is the executive editor of The Skeptical Libertarian.