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/

Part 4: Cone of Silence

One of the driving notions for the HIPAA rule is that patients have the right to access their personal medical data and take it with them wherever they go. This idea was naturally expanded by the HITECH act, with the vision that one EHR should talk to another being a key part of the original plan. The government hoped that all EHR systems would eventually be interoperable.

However, business forces were working against that from the beginning. A free exchange of information meant that patients could easily take their records and leave one doctor to be treated by another, in a different practice or hospital. This is of course not good for business, and hospitals were loath to let such proprietary value walk out the door. So while possible, moving medical records is often far from easy. On the software side, EHR companies had few incentives to interoperate while they were concentrating on gobbling up market share. Indeed, being the most widely-used system in any given healthcare region could be seen as a boon, and if it was difficult for the non-users to work with that system, all the more reason to encourage them to adopt the status quo. Meanwhile, it seemed unrealistic to insist that the various systems share data in the early years of adoption, because 90% of the nation’s doctors and practices had no system or data to exchange.

Now, in the light of the difficulties of using EHRs and exchanging information between them, or even obtaining records from them, there are many problems that need to be addressed. Yet getting information about the various failings of these expensive systems is proving just as difficult. EHR vendors often have contractual gag clauses that discourage or prohibit buyers from speaking publicly about problems with the systems, even when those issues present real safety risks to patients. The KHN and Fortune article points out that two doctors who spoke candidly about problems with their EHR later asked that they not be identified by name as their health care organization had forbidden them to talk.

Additionally, many EHR vendors have contract stipulations known as “hold harmless clauses” that shield them from liability in the event that a hospital is sued for medical errors. This may be why so many of the lawsuits filed against hospitals that relate to the use of this technology are settled out of court, with the records only saying that the EHR vendor has denied all liability.

It is clear that both the cone of silence around individual EHR systems and the forced silencing of their critics and users must end if progress is to be made with the national network of medical records.

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