Healthcare EHRs and Reality
Do you know what ONC represents? Do you know the meaning of interoperability? Do you know what API is and how it relates to healthcare EHRs?
The Office of the National Coordinator for Health Information Technology (ONC) is a staff division within the U.S. Department of Health and Human Services, primarily focused on implementing an interoperable, private and secure nationwide health information system and supporting the widespread, meaningful use of technology. ONC was created in 2004 through an executive order by President George W. Bush, and was legislatively mandated in the Health Information Technology for Economic and Clinical Health Act.
API, an abbreviation of application program interface, is a set of routines, protocols, and tools for building software applications. The API specifies how software components should interact and are used when programming graphical user interface (GUI) components. A good API makes it easier to develop a program by providing all the building blocks. A programmer then puts the blocks together.
Put these two concepts together and you have the meaning of interoperability, the ability of computer software programs to exchange information. For the purpose of what? And herein lies the question. Of course there may be some benefit from sharing information between providers, but does anyone really believe that doctor B will not repeat the tests of Doctor A to confirm findings, especially in complex cases? And even if you had the data of a million patients with hypertension responding to various kinds of treatment that one single treatment will rise to the top as the single most effective way to control hypertension? I have purposely over-simplified this to make a point. Data mining seems to be paramount in many circles and there is value there.
Of the benefits to using computers, e-prescriptions come clearly to mind. And 9.99 times out of 10, it works great. Patients can now receive a print out of lab tests at their visits. Why didn’t anyone think of this before. Patients can go through a patient portal and see their medical records and communicate with provider and staff even though 76% of patients still prefer phone calls to emails. Computers organize, bring clarity, create data bases of information, and now you can do it all on your phone. IT has brought amazing contributions to users, and will continue to do so.
However, right now, the single source of physician frustration is the use of EHR. The frustration comes from a variety of sources.
- The system is too complex to use
- It is not tailored to realistic workflow
- It does not consider all the variables
- It takes longer to document even the simplest office visit while having to see more patients in order to make any money.
- It works great for one specialty but not for another
- …and the list goes on.
Some physicians are using scribes (we used to call them medical transcriptionists) while others are using dragon. Some doctors are entering the data themselves, and then there are others using combinations of these tools. Fewer facilities and providers attested to Meaningful Use 2 than expected and the reasons are many.
So while the IT world (ONC) is plowing ahead with ways to make medical records accessible by more and more entities (interoperability through API); there are some who are saying, hey, wait a minute, what is this really doing for me? What is it doing for patients? What is it doing to truly promote wellness?
And the really big question: Is it cost effective?