Why do EHRs suck?

They don’t. They are excellent tools for billing, which is what they are designed to do.

One reads and hears many conversations about the poor quality of EHRs (electronic health records) from the perspective of patients and their clinicians. These discussions often go to great lengths to describe the short comings of these expensive and complex tools, but rarely spend much time talking about why they are so dysfunctional.  It’s not hard to figure out. Follow the money

Neither patients nor clinicians are the customers, and (as they say on the internet) if you aren’t paying for the product, you ARE the product

EHRs are developed by software vendors and then marketed to institutions. Institutions sell health care services (provided by their employers to ‘covered lives’) to their customers, private and public third payors. These customers are interested in billing systems: systems that allow them to link payment to medical conditions and help them manage (account for, predict and limit) costs. That’s what they want to buy and that’s what the market provides. EHRs are not a medical tool.

To review:

  • Payors want financial tools. They only need medical data if it is pertinent to billing and risk management. They have no interest in care itself.
  • Health care institutions work for (are paid by) Payors (Medicare, Medicaid, and insurance companies). They are paid to arrange medical services for patients. The EHR is the tool the hospital uses to justify the payment it receives.
  • Vendors create EHRs and sell them to institutions, who are primarily interested in tools that let them document and bill for services.
  • Medical institutions then hire clinicians and require that they use their billing tools to document health care services, and generally pay the clinicians based on the care they document.
  • Clinicians use patients (the ultimate consumable raw material) in order to generate billing documents so that they and their employer can get paid.

It isn’t about health care. It’s about billing.


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