Donald Simborg, a physician and founder of the standards organization HL7, in an article for the March/April issue of the Journal of the American Medical Informatics Association writes that the federal government's efforts to promote electronic health record adoption, "if not modified, may backfire" and fail to boost care quality and reduce costs, Government Health IT reports.
Simborg writes, "The current policy of promoting adoption of EHRs requires some rethinking" because most of the financial rewards for using EHRs accrue to health care payers, while physicians are expected to pay for the system. He added that doctors are also required to reorganize their offices and alter their working habits when they adopt EHRs.
As a result, vendors have had to rely on other features to sell doctors on EHR adoption, according to Simborg. "It is these other features which have the consequence of undermining the fundamental value proposition of EHRs," he writes.
According to Simborg, physicians who use EHRs typically code patient visits and treatments at higher levels, resulting in higher revenues. "It is not known whether this increase represents a correction of previous undercoding ... as some may say, or a form of ... code creep," Simborg writes.
In addition, physicians use EHR features, such as pull-down menus, templates and cut-and-paste techniques to document patient visits, Simborg notes. He writes that while he cannot prove such documentation is less accurate than when a doctor dictates notes, there is some early evidence supporting that is the case, Government Health IT reports.
Simborg recommends a new focus "on correcting the problems in EHRs and, more importantly, on the financial environment which underlies those problems." He urges the federal government and health IT community to promote "EHRs that enhance quality, cost reduction and fraud management, even at the risk of delaying adoption" (Ferris, Government Health IT, 1/31).