A decade ago, the U.S. government claimed that ditching paper medical charts for electronic records would make health care better, safer and cheaper.
Ten years and $36 billion later, the digital revolution has gone awry, an investigation by Kaiser Health News and Fortune magazine has found.
Veteran reporters Fred Schulte of KHN and Erika Fry of Fortune spent months digging into what has happened as a result. (You can read the cover story here.)
Here are five takeaways from the investigation.
Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety.
Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." And some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software-makers have paid a total of more than $200 million to settle fraud allegations.
Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the United States. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical-records software unable to exchange information among one another.
Doctor burnout: Many doctors say they spend half their day or more clicking pull-down menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which a January report by the Harvard T.H. Chan School of Public Health, the Massachusetts Medical Society and two other organizations called a "public health crisis."
Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual "gag clauses" that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families.
MARY LOUISE KELLY, HOST:
If you have ever had an appointment where your doctor spent most of the time looking at a computer screen and typing, you have electronic medical records to thank for that. The switch from paper charts was supposed to be a great thing for doctors, for hospitals and for us patients - for the whole health care system - so much so that the federal government backed the transition, even subsidizing new computer systems for doctors' offices.
Well, 10 years and $36 billion later, this digital revolution has not gone to plan. With me now to talk about the findings is reporter Fred Schulte of Kaiser Health News. He co-wrote the story along with Erika Fry of Fortune magazine, and he's in our studio. Welcome.
FRED SCHULTE: Great to be here.
KELLY: I guess what is so staggering about your findings is that it's not just a hassle. It's not just an inconvenience. It's actually causing risks to patients' safety, and even deaths. What did you find?
SCHULTE: Yes, well, there've been thousands of incidents that have been reported of near misses, of injuries and some deaths that have - have happened because of software glitches or other problems. Sometimes it's very difficult to figure out exactly what went wrong. Sometimes it's a user error, where the company will say, well, the doctor didn't type it in right. Or he pulled down a menu, and he took the wrong item.
Other times, a test will be ordered by the doctor, and it just disappears, and it never gets sent to the lab. And so they could be waiting around for a test and not realize the result isn't coming, and that could result in an injury.
KELLY: Can you tell me one story, one anecdote that would illuminate how digital records have complicated things?
SCHULTE: Right, well, we wrote about a number of patients. But one in particular had really, really bad, severe headaches. And so she was living in Vermont. And she went to the doctor, and the doctor ordered the test that would try to get to the root of that. Well, that was a case in which it disappeared. It never was done, and she died later of a brain aneurysm.
KELLY: There are also cost implications to this and concerns that the software can be misused. You describe a practice known as upcoding. Explain.
SCHULTE: Yes, upcoding is basically charging for services that you didn't fully render. One of the things that doctors both can, in some cases, take advantage of and also complain about is that the electronic health record tends to copy and paste over and over again. And so it gets very voluminous. But one of the things it can also do is it can copy material from an earlier visit, forward it into the current visit and make it look as if the doctor had, in fact, done a lot of services that were not done. That's a problem.
KELLY: We've been talking a lot about how all this looks from the patient's perspective. What about from the doctors' perspective? There was a number that leapt out at me from your report of doctors who were describing 4,000 mouse clicks per shift, just trying to get through all the electronic documentation...
KELLY: ...They're being asked to do.
SCHULTE: Right, that was one study of an average shift for an emergency room doctor. And, of course...
KELLY: They're going to need medical treatment themselves...
SCHULTE: Yeah, well...
KELLY: ...For their carpal tunnel syndrome after all that.
SCHULTE: Yeah, it could be. It also - if you click 4,000 times, I mean, the idea that you might make a mistake once, you know, is not too hard to believe.
KELLY: So is one takeaway here that we, as patients and consumers of health care, just need to be a lot more vigilant about policing our records?
SCHULTE: Well, absolutely. I think one poll recently found that when people actually asked for and got copies of their health care records, 1 out of 5 people found some sort of error in there that, in some cases, could be a serious problem. So you absolutely need to check this out.
KELLY: So what is the alternative, go back to paper?
KELLY: Where do we go?
SCHULTE: I mean, I don't think anybody suggests going back to paper. The probable solution is that everybody working together in the best interest of the patients in order to make the health system better. But you have...
KELLY: I guess the question is, what's the incentive? What's - what would be driving that?
SCHULTE: Well, there isn't a lot of incentive to work together because big tech companies want to sell software, and they compete with one another. And, you know, they don't want to share a lot of information. You have to drag them sort of kicking and screaming to doing this. And I think that's what's going to be happening.
KELLY: Fred Schulte of Kaiser Health News, thanks so much for coming in.
SCHULTE: My pleasure. Transcript provided by NPR, Copyright NPR.