Use of Electronic Health Records Showing Some Cracks

Electronic health records (EHR) were supposed to change healthcare for the better – allowing physicians to exchange information about patients they were treating, giving patients access to their records, making medical care less expensive and improving quality of care.

And to some degree, they’ve done all that.

Along the way physicians were required to adopt this new technology and make “meaningful use” of it for financial incentives. But when the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, what it anticipated didn’t quite come to pass.

In reality, the move to EHRs may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care, according to a story by The New York Times.

They reported that hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms.

“Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well,” the paper reported.

The most aggressive billing – by just 1,700 of the more than 440,000 doctors in the country – cost Medicare as much as $100 million in 2010 alone, federal regulators said in a recent report.

And it’s not just Medicare billings. It’s all the extra (and perhaps unnecessary) tests physicians are now ordering, because they can. 

“Physicians' access to computerized imaging results (sometimes, but not necessarily, through an EHR) was associated with a 40- to 70-percent greater likelihood of an imaging test being ordered,” John E. McDonough quoted a Cambridge Health Alliance and Harvard Medical School report, published in Health Affairs. 

The share of highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010, the year after it began using a software system for its emergency room records, according to the NYT.

Over all, hospitals that received government incentives to adopt electronic records showed a 47-percent increase in Medicare payments, compared to a 32-percent rise in hospitals that have not received any government incentives.

Another study found that EHRs in some cases can even lead to a poorer quality of care. The study showed that the main intent of EHRs – to free up staff to care for patients – was completely eroded by their need to learn and use the new technology.

Some experts blame a substantial share of the higher payments on the increasingly widespread use of EHRs, according to the NYT piece. “Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients – a practice called cloning – with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did,” the writers revealed.