AMDIS/HIMSS: Questioning the use of EHRs

“I don’t think we’ve saved lives by documenting more,” said Clement J. McDonald, MD, director of the Lister Hill National Center for Biomedical Communications, during his presentation at the Physicians’ IT Symposium during the  March 3 Health Information Management and Systems Society’s (HIMSS) annual convention. The symposium is co-hosted by the Association of Medical Directors of Information Systems (AMDIS).

McDonald discussed the evolution of EHRs since his first job in the 1960s. Today, “fast is not a priority—it’s the priority.” The current system displays response times so that users and developers can see when it slows. The display of response time has been there since 1984, he said.  

McDonald discussed driving forces impacting the use of EHRs:

1. Moore’s law: the idea that more power will come in smaller packages at less cost about every 18-24 months. However, small, mobile devices aren’t sufficient—yet—for proper use of EHRs.
2. The need to improve efficiency. “There is a huge need to reduce costs and improve efficiency,” he said. “There has been lots of talk about this but, so far, no serious policy attention.”
3. New laws and requirements. EHRs are “spreading like wildfire,” he said, pushing 80 percent use in some specialties.

However, time-motion studies are not encouraging when it comes to improved efficiency. For example, McDonald cited a study of just nine family practitioners who reported an average loss of 60 minutes of free time per clinic days. “Those are significant results.” In a study of more than 400 internists, 15 percent said they had “more” or “much more” free time, but 59 percent said they had “less” or “much less” free time.

EHRs are stealing provider time from patients, driving primary care providers to other pursuits and adding expenses and reducing efficiency, McDonald said.

McDonald also questioned the accuracy of medical errors reported by the Institute of Medicine. “The numbers are exaggerated.” The cardiac death rate is down 70 percent since 1960 and a decline of 2 percent per year continues today. There also are 1.2 million fewer heart attack deaths per year than there were decades ago.

Clinical care as well as technology is changing very fast,” McDonald said. “We should push back, but at the research level, to find out what works.”