While the number of physicians who use computers to store patient information is rising, most are still clinging to large manila file folders to record and retain complete patient histories.  U.S. News and World Report reported on February 20, 2013 that, in spite of incentives from the U.S. government, a study conducted by Adam Write, a senior research scientist at Brigham and Women’s Hospital and an Assistant Professor of Medicine at Harvard Medical School in Boston, found that doctors are slow to adopt electronic health records (EHRs), with only 1 in 6 using the new technology. 

The findings of the study raise concerns about whether medical practitioners will be able to comply with a 2015 deadline imposed by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (Stimulus).  Failure to meet the deadline will result in stiff federal penalties.  The HITECH Act provides incentive payments of up to $44,000 to providers who implement a certified EHR that meets the Centers for Medicare and Medicaid Services (CMS) “meaningful use” requirements, including active allergy lists, drug allergy interaction checks, vital signs, demographics, smoking status, active medications list, electronic prescription generation, reporting clinical quality measures, drug formulary checks, patient reminders, and patient-specific education resources, among other functions. 

A June 25, 2009 report by the Heritage Foundation questioned the wisdom of committing $20 billion of the taxpayer’s money to enable doctors and hospitals to purchase a good they are already buying on their own.  The report also cited a number of hurdles, including payment rules, certification standards, and definitions of key terms that needed to be clarified in order for this initiative to move forward.  The Heritage report also cited cultural issues that would impede progress by established doctors, who might find it difficult to make the institutional transition.

The U.S. News article also highlighted ongoing concerns that patients might have related to the privacy of the information being stored in the EHR, which is understandable in light of healthcare breaches that have occurred.  An August 22, 2011 CAGW blog post addressed a case in California where patient information was stored online without proper security measures, making the material vulnerable to being viewed by anyone on the Internet.  On October 11, 2012, an article in FierceHealthIT disclosed that CMS had 14 breaches of protected health information between September 23, 2009 and December 31, 2011, affecting 13,775 Medicare beneficiaries, and that CMS failed to meet several HITECH Act notification requirements.

Another stumbling block physicians may encounter when using EHRs is the use of electronic alerts, or red flags, within the system.  These are alerts that appear within the EHR to warn a physician when a patient has an allergy or other significant medical condition, or to notify the physician of recent test results.  A March 5, 2013 CBS News report covered a JAMA Internal Medicine study, which cited the potential for doctors to skim through these electronic alerts in order to get through the full patient records more quickly.  The survey results revealed that 87 percent of doctors said the number of alerts they received was unmanageable.  Seventy percent said they were getting more alerts than they could handle, and 56 percent said the system might lead to physicians missing important patient test. 

On March 20, 2013, the House Energy and Commerce Subcommittee on Health held a hearing on “Health Information Technologies: How Innovation Benefits Patients.”  Senior Vice President for Clinical Development and Strategy at Mckesson Health Solutions Dr. A. Jacqueline Mitus testified that widespread interoperability could make the meaningful exchange of information possible, lowering costs and supporting outcome-based health initiatives.  Dr. Mitus further stated that the industry is trying to improve interoperability issues to enable different health IT systems to communicate with each other. 

Dr. David Classen, an infectious disease physician at the University of Utah School of Medicine and chief medical informatics officer at Pascal Metrics, testified that “the U.S. government is investing billions of dollars toward meaningful use of effective health IT so that all Americans can benefit from the use of electronic health records (EHR).”  Dr. Classen further testified, “It is widely believed that health IT, when designed, implemented, and used appropriately, can be a positive enabler to transform the way care is delivered.  Designed and applied inappropriately, health IT can add complexity to the already complex delivery of healthcare, which can lead to unintended adverse consequences, for example, dosing errors, failing to detect fatal illnesses, and delaying treatment due to poor human-to-computer interactions or loss of data.”

The initial start-up costs of these systems are being borne by physicians and, because of the federal incentives available, taxpayers.  However, there are already documented risks that inefficient or insecure deployment of the technology will be burdensome to patients and costly to taxpayers, while also causing potential delays in treatment, and potential data breaches of personal health information.