Community Forum: Health records problems must be solved

This week’s writer is Dr. Marvin Malek, MD MPH, who is an internist working at Central Vermont Hospital in Berlin.
The financial problem that occurred recently at Porter Hospital isn’t the first and won’t be the last cost overrun we’ll see in Vermont related to the adoption of electronic health records (EHRs). Unfortunately, Angelo Lynn (Addison Independent, Jan. 10) grossly understates the magnitude of the health information technology (HIT) problem in the health sector, dismissing the Porter case as a mere cost mis-estimation.
Hospitals and doctors’ offices are being mercilessly fleeced by medical software vendors. The promise of cost savings in health care resulting from computerization is the polar opposite of what we’re actually seeing. And needlessly high cost is not the only — nor the most important — problem with the current HIT (health information technology) situation: The software itself is abysmal. Compared to available software available for numerous other functions, the quality of the software available for health care users is of a caliber we might have expected in 1993, not 2013. It’s annoying, it’s slow, it doesn’t get the job done. If you don’t believe me, just ask any health care worker what they think of their software. If Steve Jobs were to look at this software, he’d be rolling over in his grave.
Since electronic health records have the potential to drastically reduce medical errors, the disappointment within the medical and nursing professions has been enormous. The favorable hype that has been transmitted to the public about this has been coming from two sources: Those who don’t actually use the software, and those who are profiting from HIT.
These twin dilemmas of poor quality and high cost both result from weak leadership both within both government and the medical profession. Lacking a strategic plan to create a seamless, high-quality information system, the Bush administration decided to take a passive approach: simply use increasingly powerful financial incentives to get providers to adopt an HER — any EHR. It didn’t have to work well, it didn’t have to be affordable, and it didn’t have to communicate with systems other doctors and hospitals were using.
What’s especially sad is that within the federal government itself, a model for EHR adoption already existed which had succeeded beyond anyone’s expectation: During the 1990s, the VA system was converted from a medical backwater to the forefront of high-quality medical care with their well-liked “Vista” software as the centerpiece of the effort. This software is now used by every clinical worker in the VA system. This linkage of every VA facility in the country with the same, user-friendly software program is an achievement the private sector will not achieve for the foreseeable future — a decade at the very least.
So HIT in the private sector has truly become a tower of Babel. Each hospital and doctor’s office uses separate user-unfriendly and expensive software systems that don’t communicate with any other provider’s equally inadequate system.
It’s a sad situation. And one that no one in leadership positions either in government or within the health sector seems to want to address.
It’s not too late for the state of Vermont to start addressing this unfortunate situation:
1.      The Green Mountain Care Board (GMCB) should survey health providers to assess the cost and provider satisfaction with software systems they’re using.
2.      Until now, policy makers in Vermont have not regarded the cost of EHR adoption as one of the areas we could look to in the effort to achieve control over our health care costs. Remarkably, when the state of Vermont released an annual report on health cost inflation last year, they even went so far as to completely exclude HIT costs from their analysis of hospital cost inflation. There is no justification for walling off HIT costs into an untouchable, sacrosanct category.
3.      And most importantly, Vermont’s health policy leaders — both in government (e.g. Green Mountain Care Board) and in the private sector — should promote the adoption of a single, user-friendly software system. If appropriate technical support can be obtained to support the transition, having every provider in the state of Vermont adopt the VA’s software system would be preferable, since it is well liked by users and available free of charge in the public domain.
Health information systems are the linchpin of the effort to improve quality and control cost in health care. Linking all health care providers with a single high-quality, affordable software system would be an enormous achievement for the state of Vermont. Only by combining a single, seamless information system with a single-payer financing system will Vermont be able to achieve the cost-effective, high-quality system Vermonters deserve.

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