When the Veterans Affairs and Defense departments meet on May 14 to discuss interoperable electronic health records, it will be 37 years since the idea was first proposed to share medical information for returning service members and veterans.
Efforts to get the two systems to communicate with each other include provisions in the National Defense Authorization Act for Fiscal Year 2008 and a Sept. 26, 2018, joint statement to implement “a single, seamlessly integrated electronic health record that will accurately and efficiently share health data between our two agencies and ensure health record interoperability with our networks of supporting community healthcare providers.”
Despite being well aware of the time it had already taken — 27 years and billions of dollars for failed efforts to get the VA and DOD to create compatible EHRs — Congress in 2009 decided to take unprecedented action to push the private sector into adopting a nationwide system in a ridiculously short period of time. One of the provisions of the $836 billion American Recovery and Reinvestment Act of 2009 was the Health Information Technology for Economic and Clinical Health Act.
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To maintain existing Medicaid and Medicare reimbursement, the HITECH Act required health care providers to implement and prove the meaningful use of EHR by the end of 2014. The law also included financial incentives of more than $27 billion. Obamacare then doubled down on the EHR requirements with additional regulations, requirements and enforcement for health care professionals to streamline their processes through digital records.
To date, the stimulus provisions mandating EHR have cost taxpayers $36 billion. A joint investigation by Fortune and Kaiser Health News, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” released on March 18 said that, instead of “an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork,” which has “handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it.”
In short, the government EHR “open season” created winners and losers, wasted taxpayer dollars and broke more promises. It did not make medicine safer, health care better or save money.
The investigation revealed that “instead of streamlining medicine, the government’s EHR initiative has created a host of largely unacknowledged patient safety risks.” They found “alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories.”
The investigation found that 96 percent of hospitals now have EHR systems, up from 9 percent in 2008, but doctors gripe about spending more time loading information into unwieldy systems than they do with their patients. The proprietary nature of the systems makes it practically impossible to have a true portable health record that a variety of doctors can access or patients can share with their clinicians.
The systems have made it easier to inflate bills and, even worse, have introduced a large amount of safety risks due to software problems and user errors. Lawsuits abound due to hospitals withholding health records and vendor gag clauses that prevent health care entities and individuals from speaking publicly about faulty installations and software glitches.
The concept seemed simple: creating a unified, digital database, like an ATM, that would allow multiple providers to share insights instantly, lessen possible wait times and reduce costs through bureaucratic paperwork. But, when the government throws a lot of money to do something quickly while simultaneously creating rules and regulations that guarantee the money will be wasted, inevitably the concept will become a massive boondoggle.
The EHR disaster is one of many federal health care interventions exacerbated by Obamacare and represents yet another cautionary tale for preventing even more government control over health care, like “Medicare for All.”
Centers for Medicare and Medicaid Services Administrator Seema Verma has taken some steps to improve the EHR mess. She has threatened to penalize companies that block information from being shared, reduce the paperwork burden for physicians and eliminate gag clauses. In another sign of some promise for the idea of compatible EHR, the two-largest companies in the industry, Epic and Cerner, agreed to share information with each other last summer.
With billions of tax dollars, and most importantly thousands of patients’ lives, at stake, much more must be done to allow complete, accurate and easy accessibility to electronic health records across every health care system, both in the federal government and the private sector.
Tom Schatz is president of Citizens Against Government Waste.
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