The electronic health record (EHR), we were promised, would greatly improve efficiency and quality in medical care. The results have been far different, writes physician and researcher Hermann W. Børg, M.D., in the summer issue of the Journal of American Physicians and Surgeons.
Promoted as a way to facilitate evidence-based medicine, EHRs have ignored evidence in their own development and implementation. They are in fact “an experiment presented by the industry as proven medical technology,” Dr. Børg writes. “Unlike for any other ‘medical device,’ marketplace surveillance of EHRs was never done. No informed consent for its use is required. Those are extraordinary regulatory accommodations for an experimental technology.”
A “disturbing array of unproven assumptions, wishful thinking, and special effects” characterizes the research cited to convince government to enact subsidies and mandates designed to force rapid adoption of EHRs, he states.
Based on the available evidence on EHRs in actual use, Dr. Børg concludes that the net effect on physicians and patient care is negative. The real beneficiaries are government and corporations offering prepaid medical plans. The EHR is actually designed to meet their needs, not the patients’. “Those entities have agendas incongruent with patients’ interests,” Dr. Børg states. They are interested in reducing their expenditures by channeling medical care into their cost-containment protocols.
EHRs enable insurers to virtually control physicians’ way of practicing medicine. “Physicians’ work can be analyzed in terms of profitability or cost to the government and to corporations,” Dr. Børg explains. Subsequently, “counter-measures” can be applied by CDS [clinical decision support] systems to eliminate “undesirable” orders by physicians, or to coerce clinicians to order medically substandard but less expensive modalities.
EHRs are detrimental to patients as privacy is lost and care becomes computer-centered, not patient-centered.
Dr. Børg recommends a comprehensive public education campaign about the oppressive and detrimental nature of the current model EHR. Such education should start in physicians’ offices and spread by social and mainstream media.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.