NOSH ChartingSystem

A new open source health charting system for doctors.


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Picking a Scab with a Zombie

In Dr. Jacob Reider’s blog post, which was posted a The Health Care Blog on April 3, 2017, he posits that:

“I disagree with the growing meme that ONC has broadened its certification scope too far.”

He argues that the before the time of Meaningful Use and CCHIT, that EHR companies were selling products that claimed features that didn’t do what they said they would do.  He goes on to explain that developing standards through a costly and rigorous certification process, that it gave physicians confidence in the EHR product they were using.

Now, I get where he’s trying to go with this argument as we all, in an ideal situation, want to have standards between systems so that they are talking to each other in the same language.  The problem is, the solution that was offered in EHR certifcation associated with Meaningful Use had nothing to do with interoperability but all to do about dictating how information is entered into the system.

If you read the comments section of the post, it appeared that Dr. Reider, in his attempt to praise and wish luck on the new incoming ONC leader Don Rucker, inadvertently picked and opened a big scab that was the disastrous approach of Meaningful Use and how it went about stifling innovation, leaving many physicians frustrated with their EHR systems, killing off independent practices (like mine) who were doing their due diligence in seeing Medicare and Medicaid patients in innovative settings that included the use of EHRs before the time of Meaningful Use, and now with clinics, hospitals, and health entities straddled with the huge cost of maintaining these questionably useful or safe EHR systems for years to come.

By Dr. Reider’s metrics of 1) interoperability and 2) giving physicians confidence in their EHRs, I believe both counts have failed miserably.

Have you ever heard a physician having confidence in their EHRs?  Many feel that entering information in their EHRs’ are eating up half the doctor’s work day.   In a damning article on the Millbank Quarterly, EHR companies are still blocking data even with all the certifications and standards (like FHIR) that have been developed to reduce barriers for interoperability.  The simple answer is that with the monopolization of EHRs following Meaningful Use legislation and costly EHR certification, it has lead to a point of the EHR companies refusing to give an inch for any measures that would affect their market share.  The consequence of this type of regulatory capture is that these large EHR companies don’t have to cater to the needs of the physicians and their patients because there are no other cost effective or innovative options for physicians to choose from anymore.

Despite the clarion calls by many to make current EHR’s more user friendly and safer, I don’t believe there will be enough pressure or motivation for these EHR companies to change swiftly and deliberately.  For them, the bottom line is to maintain these poorly crafted certification measures through legislation and maintain the status quo.  In the end, physicians are using EHR’s that do not work well, lack innovation and vitality, lack rigorous peer review from end users and patients, lack sufficient safety data, and ultimately needs to be propped up by legislation to be legitimate.  Hence, I call them zombie EHR’s.  They are already eating up a physician’s time and pretty soon they’ll be eating physician souls and chewing away patient privacy.

zombie