Remember The EMR!

I have been railing against the roll-out of the electronic medical record (EMR) since I first started blogging when I was CEO of NorthBay Healthcare.  I have continued whining about EMRs in this space.  I have become a serial whiner.

At times I feel like I am beating a dead horse except this horse is not truly dead.  The EMR horse continues to consume oats and spew out you-know-what at the other end.  It’s a mess.

My latest bout of EMR whining is prompted by an excellent article in the April issue of that well-regarded medical journal–Fortune Magazine.  It relates the EMR follies and how good intentions were subverted by poor planning, political posturing and the law of unintended consequences.  Business as usual in D.C.  It is a must read.

Health policy makers (also know as pundits) and politicians on the hustle are a toxic mixture.  It never ceases to amaze me how ignorant these people are about the actual delivery of healthcare.  Yet it is these people we rely upon for considered reform of health care.

As the Fortune article points out, the push to have national adoption of the EMR was because it was viewed as a shovel-ready endeavor which could help with economic recovery from the recession of 2008.  However, the shovels were not ready, physicians and hospitals were not consulted and the providers of EMRs were selling a product which complicated the delivery of care and in many instances caused injuries.

The EMR vendors saw explosive growth after 2010 when healthcare providers were under the gun to adopt EMRs.  The federal government created financial incentives to adopt the EMR as well potential penalties for not doing so.  The EMR vendors as a group were not ready for prime time but they sure prospered.   Their revenue growth was impressive and matched only by their ability to not deliver on their promises.

As I have related recently, we now have scribes entering medical data so that physicians can be freed from that task and devote more time to attending to their patients.  Costs have not gone down as a result of the EMR; they have increased substanially.   And because of the poor design of the EMRs, the quality of care has often been affected.

Making the EMR work to the benefit of providers and patients is now a rescue effort that is likely to involve significantly more expense.  Even most of the early proponents of the EMR including former President Obama are expressing regret about how a good idea turned into a fiasco.

Has the lesson been learned that a good idea is not necessary amendable to uninformed political intervention?   The answer is a resounding “No!”

“Medicare For All” has again reared its head, promoted by a multi-millionaire socialist (only in America is that possible) senator with the 150 Democratic presidential candidates all supporting it.  The other party meanwhile seems to be pretending there is not a problem in terms of healthcare coverage.  Both sides give new meaning to the term “useful idiots”.  Actually, the term should be “useless idiots”.

We have a problem.  Medicare for all is not the answer.  It is an empty slogan meant to be defined in multiple ways.  There is political safety in vagueness.

Doing nothing is likewise not the answer although that seems to be the default position of the other party.

Adopting a solution for political purposes will repeat the EMR fiasco.  Wiping out the health insurance business which needs to be reformed but not eliminated will have its own unintended consequences.  Doing anything that increases demand for healthcare without providing more trained providers will simply make access even more difficult.

Solving the vexing problemn of universal coverage is going to require much more thought than blindly adopting a nonsensical slogan like “Medicare for All”.  A much better slogan would be:

“Remember the EMR”.

A poor memory will result in yet another fiasco and more importantly no improvement in coverage.


The April 17 Wall Street Journal contains an excellent column written by two academics, one of whom frequently writes healthcare related articles for the Harvard Business Journal. The article critically examines “Medicare for All” and contrasts the failing Canada model with much more successful universal coverage models in Germany and Switzerland, both of which maintain a robust private healthcare sector. The last paragraph nicely summarizes the authors’ point:

 Con­sumers and the pri­vate sec­tor drive the health-care sys­tems in these coun­tries, which ac­com­plish ex­actly what Mr. Sanders and his sup­port­ers say they want—uni­ver­sal cov­er­age, con­trolled costs, high qual­ity and ready ac­cess. In con­trast, Cana­da’s ex­pe­ri­ence shows the dan­gers of the Medicare for All model.

 So once again, Remember the EMR!

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