Bad Outcome at Brigham and Women’s Shows EHRs are Unhealthy
The US healthcare system doubled-down on EMRs with American Recovery and Reinvestment Act of 2009. Endless challenges such as integration and meaningful use standards have plagued the industry since day one. Regardless, today 83% of all physicians use an EMR.
Seven years later however, the big question is: was CMS’s ~$30B bet worth it? As a technologist who has been an active participant in the disruption of many industries with technology, absolutely not. I’ll reference three data points:
- Two-thirds of doctors are dissatisfied with EMRs
- Less than half of doctors think EMRs will improve outcomes
The third data point is becoming painfully apparent — if not ironically so — in ongoing narratives here in Massachusetts, the hotbed of healthcare innovation: EMRs are insanely expensive to implement and maintain. Brigham and Women’s Hospital is perennially recognized as an elite healthcare and academic institution, and itself no stranger to innovation. However, as hospital president Dr. Betsy Nabel announced , Brigham this year had its first shortfall in 15 years. The $50M deficit is largely tied to its implementation of Epic, after expecting more than a $120M surplus. The hospital’s implementation was part of Partners HealthCare’s 10-hospital, $1.2B transition to Epic.
Brigham, however, isn’t alone, not even by statewide standards, and not even within Boston’s regional technology hub. Lahey Health, a hospital network in Burlington, MA, cited the switch to Epic as a primary reason for its own $21M deficit and 130-person layoffs, due to training, support, and reduced patient volume.
Is healthcare destined to be a technology wasteland of outrageously expensive, underused, detested systems? I think not. But to truly move forward and evolve healthcare with the technological faculties that have modernized and improved consumer industries, the focus must shift away from record-keeping to deriving value, specifically, improved care, experiences and quality.
As Theresa Brown so aptly stated in her opinion piece, “When Hospital Paperwork Crowds Out Hospital Care” in the New York Times December 19, “We need to streamline our records so that they serve just one master: the patient… Otherwise the content of our care will be increasingly warped by the demands of our e-record systems”.
I actually believe that EMRs will stick around, but not because they’ll transform healthcare, more because so much money has already been spent and earmarked there’s no turning back. But, rather than be the face of healthcare, they’ll operate in the background as data repositories. However, next-generation healthcare technologies look and act much different, closely resembling other consumer technologies, and focused on value, not electronic paperwork. Adoption of these new-age, patient-first technologies will happen much, much faster than they’re EMR brethren.
Stay tuned in 2016 as the conversation about cost of care and cost of technologies shift to performance-based metrics that require hospitals and health systems to derive value from technology, not just stand it up.