On March 18th, 2019 Fred Schulte and Erika Fry published the article “Death by 1,000 Clicks” on Kaiser Health News (KHN), a collaboration between KHN and Fortune Magazine. The article reviewed the findings of a three-month long investigation into the United State’s implementation of electronic health systems. Their key take-aways are summarized below.

Read the whole article at khn.org/news/death-by-a-thousand-clicks/

EHR Systems have steep costs and many benefits, both realized and perceived.

Part 3 – Costs and Incentives

Transforming America’s healthcare information landscape was never expected to be easy, or cheap. In the depths of the recession, however, it seemed exactly the sort of project that the government could apply stimulus budget to that could propel job growth and innovation in a vital sector of our economy. And so in February 2009 the HITECH bill was passed, which set aside a large portion of stimulus money for health information technology. The spending was outlined as an incentive program. Physicians who could prove they were meaningfully using a government-certified system would qualify for a federal subsidy of up to nearly $64,00, paid over a period of several years. This would offset the cost of transition as well as provide the financial incentive for swift and early adoption. Meanwhile, vendors had to develop new EHR systems that met government requirements for certification.

By simple adoption, the HITECH effort can be considered a success; today, 96% of hospitals use EHRs, which is up from 9% in 2008, before the stimulus package. However, the development and implementation of these systems has been plagued with problems, not the least of them accusations of corruption. The overhaul was expected to ultimately reduce healthcare costs for the consumer and the country, as information would be easier to share and superfluous tests and treatments might be reduced. Yet some say that EHRs, which were originally optimized for billing, not patient care, have made it easier to “upcode” and inflate a bill, although measures have been implemented to help catch such fraud as well.

Perhaps the most obvious growing pain for this system was the development of the EHR software itself. There was little control imposed over the developers, and almost any system seemed to be qualified as ‘government certified.’ Because of the huge cash incentive for developers to bring a product to market immediately, what could have taken a decade to mature was attempted in a few short years. The marketing frenzy that ensued led to lavish dinners courting doctors, high-dollar trips around America on advertising tours, and the eager adoption of systems that were not truly ready to be implemented on a large scale. “Athenahealth held “invitation only” dinners at luxury hotels to advise doctors, among other things, how to use the stimulus to get paid more and capture available incentives,” states the Fortune and KHN article.

With such a focus on quick adoption to cash in on the government incentives, the oversight available was not enough to keep up. This may have contributed to the growing evidence that some doctors and health systems overstated their use of the new technology, leading to a potentially enormous fraud against Medicare and Medicaid that will take years to unravel. The HHS inspector general estimated that, by June of 2017, Medicare officials had sent more than $729 million in subsidy payments to providers that didn’t deserve them. Further audits have discovered overpayments in 14 of 17 state programs that were reviewed, totaling more than $66 million.

Our summary coverage will conclude next month with a review of interoperability.