Without Universal Health Care, Adopting Electronic Health Records Becomes Harder

In his January 6, 2017, interview with, President Obama said that one of the great disappointments for him regarding the Affordable Care Act (aka, Obmacare) was the difficulty in getting doctors and hospitals to go paperless. His interviewers, Ezra Klein and Sarah Kliff, expressed surprise that the President chose this as one of the great disappointments of such a controversial law. But I get it.

The U.S. is a world technology leader. Home to the world's largest and richest tech companies like Apple, Microsoft, Intel, Google and Facebook. But whether we are the best in tech is a matter of debate. Some believe Israel is tops in tech, claiming it has the brightest software engineers in the world, responsible for creating the best firewall software and other tech innovations. Still, others give a shout-out to Denmark, Finland, Sweden and Estonia, well known for extending tech to all of its citizens who use it in the everyday lives, even more than Americans.

But despite the great things that other countries are doing with tech, I think it is fair to say that that America has the resources and capability to lead the world in health information IT; if we wanted to. And maybe that is the primary reason that electronic health records (EHRs) are still a hope of Obama's.

What Are EHRs And What Are The Benefits and Challenges Of Using Them

Electronic health records are digital records created on a computing device by doctors and other medical care providers and staff about a patient's treatments and care. They have many potential benefits for patients and doctors, including:

  • Less paperwork—won't have to provide the same basic information to every new doctor
  • Fewer medical errors—doctors can receive warnings and alerts about allergies and prescribed drugs
  • Easier remote access that may also expand the use of telemedicine—patients can communicate with providers online and make appointments
  • Better diagnosis—doctors have a more complete and up-to-date picture of a patient's medical status
  • Less diagnostic testing—doctors can see previously ordered tests and won't duplicate unless necessary
Electronic health records also come with many challenges, including several mentioned by President Obama in his Vox interview. These challenges include system costs, integration and compatibility issues, required training time and costs, data security issues, increased workload and distraction of caregivers.

Depending on whom you ask, the benefits of electronic health records outweigh the challenges. And no one can say that the U.S. government has not provided a lot of resources to make the benefits of EHRs a reality, using financial incentives and disincentives.
In 2009, Congress passed the federal Health Information Technology for Economic and Clinical Health Act (HITECH Act), as part of the American Recovery and Reinvestment Act (ARRA) economic stimulus bill. This Act provided millions of dollars in funding and other resources to health care providers adopting EHRs. In 2010, Obamacare greatly increased the monetary incentives provided in the HITECH Act. Penalties in the form of reduced Medicare reimbursements for providers that don't establish EHRS in a required period are also a part of the Obamacare law.

Hope For The Future of EHRs

And as disappointed as the President may be about the slow pace of EHR adoption, there is still hope for the future.
Several countries have and continue to implement EHRs, and we can learn from their success and challenges. Countries heavily investing in EHRs include Denmark, Italy, France, U.K., Canada, Australia, Israel, China, Germany and a few others. These countries also have some form of universal/single payer/public plus private health care option—provided by the state and paid for by taxpayers. Participation in a health insurance program is typically mandatory, and EHR standards are set at the national level.

Denmark probably has the most comprehensive EHR system, followed by Israel. But the U.S. doesn't need to attempt full-scale EHR implementation; we can have limited records for activities such as digital scans (x-rays and other diagnostic testing) prescription tracking, or just outpatient specialist care, or emergency room care. We could start with one or all of these, but even limited EHRs would be easier under a national public health care system for all U.S. citizens.
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