I’ve discussed the electronic health record (EHR) before, and plan to do so again. But before I dive into EHRs and “the A word,” I want to take a look at WHY we have EHRs.
When dinosaurs roamed the earth
In the old days, even within the lifetimes of some of us, there were no ELECTRONIC health records. There were PAPER health records, stored in large file cabinets. If you were lucky, the health records were typed; heaven help you if they were in a doctor’s famously illegible handwriting.
When a relative’s doctor retired in the 20th century, the relative requested their health records and received a huge pile of paper dating back to who knows when. In that form, it was about as useful as the huge file cabinets in which the U.S. Federal Bureau of Investigation used to store its millions of fingerprint cards. And unfortunately, paper health records didn’t have the health equivalent of a “Henry system” to find individual records quickly.
The two purposes of an electronic health record
So now that we have electronic health records, why do we have them?
- To make life easier for the doctor? Of course not.
- To make life easier for the patient? Definitely not.
Electronic health records have evolved to serve two OTHER parties.
First, electronic health records serve the billers
I can’t speak to countries other than my own, but in the United States the health “system” is a mishmash of multiple parties. For example, when I had a colonoscopy a few years ago, the following entities were somehow involved:
- The doctor who performed the colonoscopy.
- The facility where the doctor performed the colonoscopy.
- The anaesthesiologist who assisted with the colonoscopy.
- My insurance company.
- My former company (via COBRA) who provided me with the insurance.
- And probably a half dozen other entities that I missed who somehow got a cut.
So this one procedure created one, or perhaps multiple, electronic health records (perhaps even with pictures) describing every chargeable thing that could be itemized during my time in the facility. All with the proper billing codes (Current Procedural Terminology or CPT codes) and the like, so that every entity can pay what they’re supposed to pay. And if a particular thing wasn’t covered by insurance, then I had to pay it.
The most important thing is to get the billing codes right…never mind how hard it is to ENTER all the billing codes.
But the good news is that when electronic health records systems integrate with medical billing systems, the process is kinda sorta streamlined:
“By integrating EHR and billing software, healthcare providers can automate various aspects of the billing workflow, resulting in increased efficiency, reduced manual work, and other tangible benefits.”
Second, electronic health records serve the lawyers and regulators
But it’s not only the billers who need information.
To practice medicine in the State of California, you have to perform a colonoscopy in accordance with medically approved procedures. And you have to document that you did so.
If I had died on the operating table during my colonoscopy, then a number of private and government entities would have a keen interest in what was performed during the colonoscopy. And the electronic health record would be one of the main sources of information about what happened, and perhaps what went wrong. And who was responsible. The doctor? The facility? The anaesthesiologist? Someone else?
But even when things don’t go spectacularly wrong, there are laws and regulations that mandate EHR use.
“The “EHR mandate” refers to the federal requirement for eligible healthcare providers to adopt and use certified EHR technology. Primarily affecting providers who accept Medicare, participation in MIPS and the Promoting Interoperability program requires CEHRT to avoid negative payment adjustments, which effectively necessitates EHR use.”
The result
So now the medical field has these wonderful EHRs that comply with billing requirements and legal requirements.
But are they easy to use? Forbes covered this.
“For instance, emergency medicine physicians at one health system must click 14 times to order Tylenol—that’s a lot. Yet, those at another health system using the same EHR must click 61 times!”
And that’s just for Tylenol. I’m sure it’s a lot worse for the camera that looked at my colon.
It could have been worse, because many Americans are not healthy.
“[O]ur patients have increasingly complex health needs. More than 40% of American adults have at least two chronic conditions, one-third take at least three medications, and one-fifth suffer from mental illness.”
Put these and other things together, and EHRs have become (as I said before) “a pain in a particular body part.”
So that’s the problem with EHRs. Later I’ll look at the solutions, including:
- (Because I’m the biometric product marketing expert) tying an EHR to a person
- The companies working on improving EHRs with you-know-what
Bredemarket 