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LHCQF Blog

 

The Health Care Evolution, Part I


 By Cindy Munn, Quality Forum CEO

How often – especially in the last couple of years – have you heard the statement, “Health care is changing”? My guess is, you’ve heard it often enough that it now makes you roll your eyes and say, “Duh,” before moving on to the next health care-related news item.

And yet, as commonplace as that statement may be, it’s still very much a true one – health care really is changing, and it’s changing at a faster and faster pace. We live in a world that is increasingly reliant upon technology – we get our news electronically, we do our banking and shopping online, we do our research online, and we even do our socializing online, thanks to Facebook, Twitter, Instagram and LinkedIn. It only stands to reason that health care has a growing place in this tech-dependent world, right?

So why, then, is there still an element of hesitancy to adopt health information technology (IT)?

The Old Days

Since the beginning of time, health care has been in a constant state of evolution. In the Middle Ages, diseases were treated by blood letting; diagnoses were influenced by astrology; and pharmacology was little more than simplified herb-based folk medicine. It wasn’t until the 17th century that health care began to advance beyond these primitive measures – until then, these early physicians believed a positive outcome was attained if the patient didn’t die during treatment.

These days, however, technology has enabled us to reach new heights in health care – bio-artificial organs, bionic limbs, surgical robots, minimally invasive surgical techniques, hormone replacement therapy…these are just a few of the greatest health care achievements of the 21st century. 

Imagine how the “doctors” of the Middle Ages would react to these advancements. If they didn’t faint dead away from the shock, they’d likely invoke the symbol of the Evil Eye and run screaming into the night…and their patients almost certainly would.

But – and pardon me for saying it again – health care is changing, and these changes have reached lightning speed over the last few decades. It’s become an environment ripe with – and for – innovation, and it is this environment that has spurred the advancement of health IT tools like electronic health records (EHRs).

Yet – hard as it is to believe - there still remain naysayers, and while these naysayers are not exactly forking the Evil Eye at EHRs, they are clearly hesitant to adopt them.

 The New Resistance

Change is difficult – I think we can all admit that. Ask anyone who’s ever tried to quit smoking, or switched from the day shift to the graveyard shift, or moved to a new and unfamiliar city.

For physicians who’ve spent their entire careers relying on paper charts, the transition to EHRs can be a difficult one, too, especially when that transition is coupled with the requirements of Meaningful Use, altered workflows and a lack of familiarity with new technology systems. Tack HIE connectivity, data mining and patient-centric care transformation onto the to-do list for these physicians, and you can almost see the terror rising in their eyes.

But that doesn’t mean that change is bad, and nowhere is that more true than with EHR implementation. So let’s examine and discuss two of the more common arguments against EHRs, shall we?

Argument 1: EHRs interfere with my face-to-face time with my patients.

According to a 2013 RAND Corporation research report, this was cited as one of the most common sources of dissatisfaction with EHRs among physicians, yet only 18 percent of the physicians surveyed said they wanted to go back to paper charts.

While I certainly appreciate their concern for their relationships with their patients, as a health care consumer (and really, aren’t we ALL health care consumers?), I can tell you that I have a physician who uses EHRs and another who still uses paper, and I get about the same amount of face time and eye contact with both.

But as a patient, I can also tell you that while I receive great care from both, there are a few added benefits to the EHR-enabled physician – things like e-prescribing, electronic access to my health records and a faster review of my medical history when I’m in the exam room. And frankly, I rather like not having my personal health records left in a wire inbox attached to the outside of the exam room door while I wait for my doctor to enter, which brings us to….

Argument 2: Paper is safer and more secure.

Remember the doctors’ offices of your childhood? You’d walk into the waiting room and sign in at the nurses’ desk, and right behind her desk, you could see shelves with rows upon rows of alphabetized and color-coded manila folders, crammed with the private health information of every patient your doctor had ever treated. There was a stack of those folders on her desk – folders she’d pulled in preparation for appointments that day – and as she guided you to the exam room, you could see more of those folders on the doors of other waiting rooms.

Now compare it to the office of an EHR-enabled physician: no rows of folders in unlocked open areas and no folders left unattended on doors or desks. Your health information is safely digitized, encrypted and password-protected.

So tell me again how paper is safer? Explain to me how to track and record who opens a paper folder and when and why and where.

I’m waiting.

Still waiting…

And by now, you’re taking a deep breath to talk about security breaches and hackers and compromised data, aren’t you? I knew it – that’s why I visited HHS’s website and did a little research via the agency’s breach tool. A search for hacking/IT incidents, improper disposal, loss, theft and unauthorized access/disclosure of EHRs among providers in all 50 states over the past 10 years yielded four pages of results. A second search for the same breach types for paper records returned 12 pages – three times as many. (See for yourself here.)

While we’re on the subject of safety and security, EHRs are backed up at an offsite location in case of fire or disaster…Tell me how those paper charts of yesteryear are protected from fire, tornados and floodwaters and hurricanes. (If you’re from Louisiana, you’re thinking of the thousands of people who lost their health records during Hurricanes Katrina and Rita and nodding your head with understanding.)

So, both as a patient and as someone with more than 25 years experience in the health care field, I need no studies or research reports to support my argument about the safety and security of EHRs over paper records. My common sense is enough to suffice. 

Editor's Note: Throughout the week, in recognition of National Health IT Week, the Quality Forum Blog will publish a new post each day to highlight specific, key initiatives in health IT. The second part of the above blog post will be published tomorrow, Tues., Sept. 16, 2014.

The Spirit of Louisiana
The Health Care Evolution, Part 2

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