Growing up in rural South Alabama, the nearest doctor was about 20 miles away in a little town called Frisco City. His name was Dr B. L. Hanks, and he received his medical degree from Harvard Medical School. I’m told he made house calls in his younger years, but when I knew him he could barely walk. He would shuffle into the examination room, lean against the wall and run his hand through a head full of unruly white hair and ask what was wrong, while all the while looking at non-verbal signals which were just as important as anything I said. He might have been up there in years, but he was sharp as a tack. He knew all about my medical history, as well as my brothers and sisters, parents, and grandparents. In fact, he kept the medical history of most of Monroe County filed away in his head. He is still one of the finest doctors I have ever known, and I think about how he would react to the technologies in healthcare today.

The world today is infinitely more complicated. With the advances in healthcare treatment options and medications, a maze of individual insurance rules, and government regulations, not even Dr Hanks could keep up with the flood of data. Enter the Electronic Health Record, or EHR. These have been around in one form or another since the 60’s. Computer systems do a much better job of billing insurance companies, which were the first widespread applications in healthcare. There were various attempts to use computers to improve record keeping from a clinical perspective. One of the first of these was the Veterans Administration’s DHCP system, later named VistA, which, despite decades of bureaucratic attempts to make it, well, more bureaucratic, still took top place in an EHR survey of physicians in 2016. By the way, VistA is the first EHR to be developed as what is now known as an “Open Source” project (more on that in the next article).

There was a big push to get every hospital and medical office in the country to utilize EHR’s in the last ten years. The promise was that they would simplify billing, eliminate medical errors, improve quality of care, and make it easier for patients to transfer their records to other doctors and hospitals. How have they done? They are REALLY good at billing. Everything else, not so much. Here are a few of the issues:

• According to a 2018 study by Stanford Medicine, in conjunction with the Harris Poll, 40% of primary care physicians who participated felt there are more challenges than benefits and 49% feel that EHR’s detract from their clinical effectiveness.

• Another survey was done in 2018 that showed that of a typical 17 to 24 minute outpatient visit, the doctor has to spend just over 16 minutes typing information into a computer

• There is a phrase coined by practitioners, “pajama time”, that refers to the time spent at home on nights and weekends to catch up on EHR work. One study found that nearly 30 hours per month of pajama time was needed.

• Access by patients, of their own records, which was one of the main reasons for the push to implementation of EHR’s, is increasingly a problem.

• Healthcare organizations are a prime target for ransomware, a type of malicious code used by hackers to encrypt a target’s files. Once infected, the code encrypts the data that these organizations need to function, and the attackers demand a ransom to unlock the files The incidence of ransomware attacks have risen by 300% since 2015, which brings the security of current EHR’s into question.

I believe that if Dr Hanks were here today, he would see the incredible benefit of having a comprehensive and portable digital healthcare record. But I also believe he would wonder if the current implementation places a barrier between the physician and patient and leaves clinicians with the task of managing data, not healthcare. There must be a better way.