KevinMD, a prominent physician blogger for many years, posted a recent note in which he discusses the disappointing results of the broad hospital EHR deployment enabled by the HITECH act of 2009. This legislation committed us to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care (see: Disappointing outcomes despite a massive investment in EHRs). Here is what he describes instead as the consequences of this act: Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment. Here are the five reasons he says that EHRs have been disappointing:
...EHRs were designed to document the provision of health care as it was just delivered. Most EHRs arose from a programming background emphasizing billing and claims processing;....As a consequence, systems were not designed to provide sophisticated guidance to health care practitioners for “what comes next” in the care of a patient. With some important exceptions, the most important part of a patient’s medical care is the ongoing plan, and – unfortunately — EHRs still don’t effectively facilitate planning the future of a patient’s care.
...EHRs have been woefully inadequate when used for population health care management. Software companies are only belatedly realizing their obligation to enable analysis of health care needs and disparities across entire populations of patients (see: Population Health Management; Software Designed to Support ACOs). Without a well-designed and implemented patient registry, an EHR cannot identify groups of patients with similar needs, thus impeding a practitioner’s ability to direct limited care resources to patients who would benefit from intensive management.
...[E]ngaging the patient — presumably an important party in improving health care through IT — has been an afterthought. Adoption of electronic patient portals has been slow, in part because the design and user interface of portals lack polish, and in part because portals fail to provide patients with actionable information to guide personal health care management.
...One of EHRs largest failures is their inability to communicate with one another, a prerequisite to attaining the promised goals. The health care IT industry has been derelict in its responsibility to comply with standards of interoperability, and no funding mechanism has been established to develop the requisite interfaces among software systems in current use.....Diagnostic results and hospital records in one system are frequently unavailable within another electronic platform, requiring physicians to access multiple systems for these records, each system requiring a different username and password.....
...[W]e have succumbed to an all-consuming demand for privacy of health care information without considering the implications. Personal health care information provided to one’s practitioner during a visit is available only to that practitioner, ignoring the potential that the patient may present to another practitioner with a related problem....We should reasonably expect that all relevant information is immediately available to any healthcare practitioner who needs it to provide safe and effective care, regardless of facility or location, and yet we have tolerated the development of laws and IT systems that make it impossible.
Here's a link to a another recent article about why physicians hate EHRs with some overlap with KevinMD's list of problems above (see: Why doctors hate electronic health records).
Although I think that some progress is being made regarding EHRs, I doubt whether they will change in any major way over the next five or more years except perhaps for the improvement of patient portals. Hospitals have invested too much money in their current EHRs, inadequate as they are, for them to now make radical shifts to new systems. Also, the EHR vendors are making too much money for them to have any incentives to change their current systems. EHRs will remain largely as they exist today in the short-term and all of us will learn to live with this. The most interesting health IT changes will be seen with the diagnostic cloud systems that process cancer genomic information (see: New IT Model for Cancer Genomics; Diagnostic Cloud Nodes). The esoteric diagnostic labs that deploy these specialized systems in the cloud will keep a safe distance from EHRs in order to avoid their gravitational pull and inevitable dumbing-down.