How to Fix the EHR Mess

Computers, more specifically, electronic health records (EHRs), will someday revolutionize the practice of medicine. In fact, successful computerization of medical care is the most critical step necessary to transform the American health-care system from its current sorry state to the 21st century system of our dreams. It is ironic, then, that today EHRs represent one of the worst problems plaguing medical professionals. At this point, many physicians would say that EHRs have created more problems than they have fixed. The most important question is how do we get from where we are to where we need to be?

Dr. Matthew HahnFirst, it is important to discuss how we got to this current state. Initially, just about everyone assumed that the transformation from a paper-based system to a computerized one would be easy—it seemed a given that modern computer capabilities would automatically make things better. So, in the early 2000s, the Bush administration stood back, assuming the magic hand of the free market would create and distribute the best and least expensive computer systems to all physicians. This was a big mistake. Available systems were often very expensive, and many physicians complained that they were largely unusable. As a result, by 2010, only a small percentage of health professionals were using full-fledged EHRs.

In 2011, the Obama administration attempted to rectify this situation. This proved to be an even bigger mistake. Government bureaucrats assumed that high cost and resistance to change were the problem. They rolled out the “Meaningful Use” (MU) program, which for two years was voluntary, but by 2013, carried penalties for those who did not participate. The program offered $44,000, spread over five years, for physicians who used EHRs certified according to MU standards, and who used those EHRs (and reported data to prove compliance) according to complicated MU criteria. The combination of monetary incentives and penalties pushed physicians to purchase EHRs in great numbers...