Electronic health records (EHRs) hold the promise of improved patient care but also confer the frustration of inconvenient technology.
At a Senate Committee on Health, Education, Labor and Pensions hearing this week, AAFP President Robert Wergin, M.D., of Milford, Neb., told senators how EHRs have helped and hurt in his practice. The committee sought testimony(www.help.senate.gov) on how to use the technology more efficiently.
"Family physicians were early adopters of health IT because we saw the potential for improving patient care, and we still see that potential," Wergin told lawmakers(www.help.senate.gov).
But he also talked about his own difficult experiences in adopting electronic records.
"Four years ago my practice implemented an EHR (system), and I have to say it wasn't pretty," said Wergin. "The transition was expensive, time consuming, and resulted in a decline in office productivity and loss of patient volume. But we worked hard at it, learned the system and productivity improved."
- AAFP President Robert Wergin, M.D., of Milford, Neb., recently told members of the Senate Health, Education, Labor and Pensions Committee about the benefits and downsides he has encountered in adopting electronic records.
- Technology supports innovative health delivery models, but regulatory burdens interfere with the doctor-patient relationship, Wergin said.
- Senators acknowledged the difficulty physicians encounter trying to integrate complicated technology into their practices.
On the positive side, Wergin noted that health IT supports innovative health delivery models such as medical homes and telemedicine that are time-intensive and depend on technology but are not adequately reimbursed under the current system. He also noted that health IT supports advanced functions such as electronic prescribing, clinical decision support and accessing lab results.
On the other hand, Wergin told senators, physicians who implement EHRs have to spend too much time on tasks that have no relationship to patient care.
"Regulatory burdens are interfering with the doctor-patient relationship," Wergin said. "Current EHR (systems) are expensive and do not function well within the physician's workflow and are not fully interoperable."
Senators on the committee made it clear they knew that some requirements of the federal government's EHR meaningful use program, combined with vendor competition, hinder improved patient care.
"The hope was the program would improve care, coordination and reduce costs," said Sen. Lamar Alexander, R-Tenn., who chairs the committee. "The evidence suggests these goals haven't been reached."
Citing a 2014 Medical Economics survey(medicaleconomics.modernmedicine.com), Alexander said most physicians do not think their EHR systems have been worth it.
Physicians who do not adopt EHRs stand to lose 1 percent in Medicare payments this year. In 2016, the penalty rises to 2 percent. The AAFP has sought to delay the penalty phase because of the lack of interoperability among EHR systems.
"Instead of the government trying to make everybody do this by taking away Medicare payments, a better route might have to find ways to enable and encourage their adoption," Alexander said.
Both Democrats and Republicans on the committee acknowledged the difficulty physicians encounter trying to integrate complicated technology into their practices under the threat of penalties.
"Many physicians across the country are facing a Medicare payment reduction this year because they are struggling to meet the requirements for the use of these electronic health records. I know there is a lot of frustration about that," said Sen. Patty Murray, D-Wash. "I think we need to do more to set high standards and ensure providers have the support and flexibility they need to reach them."
Alexander asked Wergin why physicians who accept Medicare would choose not to participate in the EHR program despite the penalty they would incur.
"A lot of it has to do with the regulatory requirements to meet meaningful use," Wergin responded. "I met meaningful use on the last day of the 90-day reporting period."
Wergin approached the deadline still needing two more patients to submit questions through a patient portal, he said, so he contacted two patients and asked them to send a question about their lab results. Without that effort, his practice would have failed to meet the standards.
"If I calculated the number of hours spent on meaningful use, it may have been a wash in terms of benefits," Wergin said. "Many practices say the time, the expense and the effort it takes make it not worthwhile and say, 'I'll have to take the penalty.'"
Sen. Bill Cassidy, M.D., R-La., asked about the cost to purchase an EHR system. Wergin estimated it at $70,000 to $80,000 per provider, noting that practices have to buy software upgrades to meet meaningful use standards. Government incentives amounted to about $44,000.
"We've got a real problem here," Cassidy said. "Productivity on the front lines is down by 25 percent."
Alexander asked those who testified to work with policymakers to provide specific, actionable recommendations for how to fix the problem.
After the hearing, Wergin told AAFP News he was encouraged by the response he received from elected officials.
"My overall view is that the senators get it," he said. "They see regulations are a problem and are so overwhelming. They get it and want to address that part of meaningful use."
Related AAFP News Coverage
Brookings Institution Forum
Panel: EHR Holds Challenges Along With Promise