The HIT Emperor Has Never Had Any Clothes

Over the last several months, I have worked to make the following the official policy of the Massachusetts Medical Society:

That the MMS will advocate to our State and Federal Representatives to end all legal constraints and financial inducements arising from the use or non-use of Office of National Coordinator (ONC) Certified EHR Technology.

That the MMS will encourage our Massachusetts Federal Legislators to introduce legislation to end the ONC’s EHR certification program, and will ask the President of the United States to immediately request that such legislation be introduced.

While the MMS’s Committee on Information Technology voted unanimously to support the above proposal, the MMS rejected the above and choose instead to make the following official MMS policy:

That the MMS will work with appropriate government entities to foster EHR innovation, affordability, and functionality by modifying the certification process for EHRs to improve patient care.

Without a doubt, ONC’s EHR certification program has stifled innovation in EHRs in particular and in health information technology (HIT) in general. In addition, the data accumulated to date has shown these ONC’s Certified EHRs have failed to have a meaningful impact on either the cost or quality of healthcare.

The 6 December 2016 issue of Annals of Internal Medicine has an article which shows that for every hour a physician is involved with direct patient care results in an additional 2 hours of EHR work (in the office/clinic) and then more EHR work from home. No wonder MDs are so dissatisfied with the practice of medicine. The accompanying editorial (Ann Intern Med. 2016;165:818-819) concludes “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system ”

I find it unfathomable that neither the MMS, AMA, ACP have tried to forcefully end MU/MACRA/Certified EHR programs. To date, these organizations have been complicit in allowing this programs to continue. While I fully understand it would take an act of Congress to end these programs, these programs have seriously crippled our ability to take care of our patients and, more significantly, have stifled EHR innovation. In addition, these programs have relegated the physicians from the prime mover in the health care world to the role of a vendor and enabled the healthcare system to be taken over by the politicians, Federal bureaucrats, EHR geeks, EHR vendors, large medical institutions and insurance companies. While physicians can rightfully claim that their first priority is to the care of their patients, none of these entities can make a similar claim. Most injurious to the entire healthcare system, in my opinion, is the fact that the large EHR vendors and the ONC now decide how physicians actually implement the practice of medicine in their own exam rooms.

While all this was happening, the organizations which supposedly represent the interests of physicians sat by and ignored our “Prime Directive” (due no harm.) They allowed ONC to create and evolve their programs, while providing ONC with “helpful” suggestions, even though there was no a priori evidence that these programs would work as intended. And once the evidence began to accumulate that these programs did not achieve the desired outcome (lower healthcare cost/higher healthcare quality), these organizations repeatedly ignored the data, they continued to believe the HIT geeks who told them “after we get over the next HIT hurdle, everything will get better” and they trembled when the HIT geeks called them Luddites for questioning the proposition that “more HIT is better.”

In my opinion, the solution to the cost half of our healthcare problem does not reside in health information technology. It will require a shift of resources away from treating chronic diseases in favor of preventing those diseases with better education, better/safer jobs, better nutrition, more accessible healthcare. And there is data to support this proposition. And there are countries which have already implemented such a system.  Unfortunately, neither our society nor our medical professions appear to be ready to accept this fact and begin doing the hard work that this solution will require.

And it still remains an open question whether more HIT will solve the “qualify” half of our healthcare problem. The data to date is not very encouraging. Yet despite this fact, HIT geeks still tell us that “more HIT is better.” The current “next HIT hurdle” is “interoperability.” As we all “know,” once all EHRs can pull/send data on demand to any other EHR, all of the healthcare system’s problems will be solved. At best, I am skeptical.

On November 30th, the American Hospital Association asked the President-elect to end Meaningful Use.  I believe the MMS, AMA, ACP and all the major medical societies should prominently and proudly support that effort.

Hayward Zwerling, M.D., FACP

13 replies »

  1. I wonder if anyone in the CMS/ONC even knew about it. They were so busy carrying water for special interests. Hard to learn from others mistakes when you aren’t paying attention.

  2. Meltoots nailed it. The only thing failing worse than the ONC’s policies are the “medical societies” who claim to represent physicians. Sad. The next several years will yield much discussion on how irresponsible CMS has been with this endeavor. There is another post proximal to this one demonstrating that CMS cannot decipher how it is failing or why, even when told in clear terms. They have tons of data which they cannot understand, and won’t act on when they do understand it. The ONC’s agenda has been recklessly polluted with special interest pet projects that are clogging the process up and harming patient care. When the message coming out of the medical societies starts reflecting the sentiments on this blog, we might actually change things.

  3. Several years ago, the National Health Service stopped maintaining their national EMR and started all over again. Maybe it’d be appropriate to see how they are doing! To have a sense of the economics involved, remember that Cerner and GE were major donors for the funding of the Institute of Medicine sponsored study that triggered all of this a long time ago.

  4. I would suggest that you take the wording from the above proposal and present it to your medical society(ies) and asked them to make it their official policy. If enough people do that, maybe it will make a difference

  5. I am in full support of Dr Z’s proposal. It is the #1 thing I promote, END EHR Certification.
    CMS and ONC has made a policy market that kills innovation. They made a Boeing/Lockheed Martin, in Epic and Cerner. MU and PQRS and HITECH has set back EHR safety, usability, efficiency, security, and interop at least 10 years. The market was moving towards EHR. ONC and CMS forced the market, implemented hypercomplex meaningless regulations on an immature market and killed MDs with burden to make up for it. ONC and CMS wanted data, even if it meant make every MD a data entry person and even if the data is poor or useless. If we left the market alone, we would have had vendors working with MDs to make software more usable, better, safer, all leading to less burden, lower cost and higher satisfaction from MDs and patients, and of course, better outcomes for all. Now MACRA, which is essentially MU 2.0 is no different in any way from MU/PQRS except in a year transition. AND they added Clinical practice improvement. How nice. They just do NOT get it. Looks like it took a presidential election to go so poorly for the Obama appointments to see maybe there is a problem. At this point, I’ll take Kim Jong Un if they will stop all the hyper-regulatory action (MACRA, EHR cert) placed on me and my fellow front line MDs. We need EVERYONE to get out of our exam rooms. Stop ALL EHR certification, the nanny state of ‘we want to be sure you don’t get bad software” did not work. We got bad software. And its costly burdensome inefficient unsafe and not secure. As MDs we want to work DIRECTLY with IT vendors to get what we need to make IT work for our practice and patients. Until then you can forget interop. If we are left getting penalized by CMS for MACRA, it will set back EHRs, medical care, interop another 10 years. Its time they admit their mistake with MU HITECH cert EHR and PQRS and get out of our way.

  6. To force digitization upon health care records was another immense mistake in a litany of astonishing errors–going back to the tax deductibility of emoloyer-provided care after WWII and the concept of the health maintenance organization and the distraction of capitation and now, payment-for-value. Toss in things like the professional standards review organization (PSRO–recall those?) and gatekeepers along the way.

    One screwup after another, all gratuitously from the outside.

    If Boeing allowed laymen to interfere this much in aviation we would still be flying in dirigibles.

    I blame ourselves…for believing we could mind the science and avoid the politics and business of our agency for patients.
    We wanted to be monks fooling around with fine wines on the side.

  7. With M.D. Price at HHS there may be hope. Professional medical societies don’t seem willing to take a strong stance….are there any that are trying to stop coercive adoption of EHR tech? How about a grass roots letter writing campaign? As a physician Price likely already knows the harm and waste that mandated EHR adoption has wrought….and might be responsive if a few thousand practicing docs wrote to him simply asking for a rollback of coerced adoption.