How EHRs went wrong


If, like me, you believe that electronic health records will play an important role in future of medicine but can’t figure out why the federal government is spending $19 billion dollars incentivizing the adoption of systems that aren’t ready for prime time, I have found an answer.

An article in the New York Times ("A Digital Shift on Health Data Swells Profits in an Industry," Feb. 19, 2013) provided a glimpse into the backstage story of some questionable associations that led to bad decisions.

Glen E. Tullman, who until recently was the chief executive of Allscripts, one of the three dominant players in the electronic health information business, was health technology advisor to the 2008 Obama campaign. Since President Obama took office in 2009, he has reportedly visited the White House on at least seven occasions. Mr. Tullman, who was quoted as saying, "We really haven’t done any lobbying," characterized his time in Washington as education. According to the New York Times article, Allscripts annual sales have more than doubled since 2009 to an estimated $1.44 billion dollars in 2012.

It appears that the lobbying efforts by Mr. Tullman and other members of the industry were instrumental in creating a timetable of incentives that had physicians and hospitals rushing to jump on the EHR train before it left the station – and before it was road worthy. The result has been huge profits to the largest digital records companies while smaller companies that may have been less ready to compete have withered, the Times said.

One could argue that this is just another example of survival of the fittest in the best tradition of American free market capitalism. The problem is that the subsidies have tilted the playing field, and the resulting products have not met the promises made by those who lobbied for them. The even bigger problem is that the government also failed to secure from the industry any guarantees that EHR systems would meet a set of minimum standards and be compatible with one another.

As physicians, we also must share some of the blame for this EHR debacle.

We have not been thoughtful consumers. Those of us in small physician-owned groups must understand the relationship between our overhead and the bottom line and carefully weigh whether an incentive makes sense for us financially. If we decide to buy an EHR, we must be good shoppers. We must visit several practices that match our demographic and have been using for several years the system we are considering – even if this means flying to other cities to get a broad sampling. We should drive a hard bargain with incentives for support and severe financial penalties for failure to produce. And we mustn’t be afraid to say to the vendors that either we or they aren’t ready.

Most of us, however, no longer practice in physician-owned practices anymore. For a variety of reasons, we have allowed others to make decisions that dictate how we practice medicine in the real world. Most of these "others" aren’t physicians, and if they were once physicians, they certainly aren’t now in the true sense of the word and they don’t have recent practical experience of seeing real patients in real time. These others are often the folks who choose when and from which vendors medical practices buy their EHRs.

By joining larger and larger provider organizations, practicing physicians have lost their ability to provide critical input into the choice of tools with which they will practice. The result has been large investments in EHR systems that neither save money nor provide better care. We can only hope that from the ashes of this first failed attempt will come a system that does what we and our patients want it to do.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail Dr. Wilkoff at

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