Summary
The article rightly emphasizes a focus on interoperability, rather than detailed EHR specifications. Even more fundamentally, no amount of automation will be effective without a fundamental change in the ways in which health care in the U.S. is paid for, its costs are reimbursed, and incentives are structured for providers, insurers, and patients.
Analysis
Electronic Health Records (EHR) are needed to improve the cost effectiveness of health care delivery in the U.S., which is consuming an excessive amount of GDP and producing overall results that are significantly inferior to other countries who spend much less in absolute as well as in relative terms. Obstacles to the widespread introduction of EHRs -with their potential benefits such as reduced errors, anywhere/anytime accessibility to a patient's health history to reduce the number of duplicate tests and provide valuable information to care givers even during emergencies far from home - include the large number of small practices who may have neither the time nor the money to invest in acquiring and learning how to use EHRs, the very fragmented nature of health care insurance and multiple data formats and reimbursement procedures, and concerns about patient data privacy and protection and the ways in which employers and insurers may potentially exploit this data to the detriment of patients. Knowledge that insurers today have staff whose incentives are based on how many claims for reimbursement they can deny - a natural cost reduction initiative given that private insurers are run for profit - does not inspire trust or confidence, while these practices add to the non-productive administrative burden borne by doctors and hospitals. Overcoming these obstacles will require not just intelligent and flexible technological solutions, but more fundamentally and more difficult to achieve a different ethos and set of incentives for all the participants in health care, from the patients themselves (i.e. us, who must take more responsibility wherever possible for our wellness and be better equipped to understand costs and alternatives) to the health care deliverers and the payers, who include the insurers and the patients (the latter both directly and collectively via their taxes). It is also claimed that many procedures and tests that are carried out and contribute to bloated costs are probably not medically necessary, but are done to minimize the chance of a law suit in the event that the outcome for the patient is not as desired (which of course may be noone's fault). The increasingly dysfunctional nature of U.S. health care reflects fundamental flaws such as the linkage of health care insurance to employment and a reimbursement or payment system which rewards curative but not preventive procedures and measures (i.e. which focuses on overcoming disease but gives no or little credit for preventing or inhibiting it). Introducing the widespread use of EHRs without basic systemic reforms will be very difficult if not impossible, and ironically even where implemented may exacerbate the problems built into today's system by increasing the speed with which errors are executed and cumbersome, even harmful processes are followed.
