EMRs (Electronic Medical Records) problems have been defined by NCHI and reported to Congress.

The nightmare of initiating and implementing the EMR has some clearly identifiable problems. The National Coordinator for Health Information (NCHI) has formulated a report to Congress on the state of the HITECH Act to develop the EMR. The federal government invested over $28 billion to aid in the development and use of health information technology in which an electronic health record would be available that would meet security requirements and could be shared in a usable format between related providers and patients as well. The end result was to improve health care and provide a wealth of epidemiologic information not to mention the huge boon for administrative policy.

The billions invested were to provide incentive programs to develop and implement the goals of the EMR. Clearly, the process has not worked as it should have mostly because of the disparate and proprietary software programs — too many vendors with a vested interest in competitive profiting and protecting their turf.

NCHI pointed out some of the offenses, for instance, “blocking information,” by charging fees that make it economically impossible to access or use the data and using transaction fees for each time a user sends or receives or even searches e-information. They charge for common types of interfaces like connecting to labs and hospitals. Providers do not appreciate the cost of extracting data from their own systems and are not pleased with how difficult and expensive it is to opt out of an existing vendor’s program in order to purchase or migrate to another. The various templates used to collect medical data are widely different, are often difficult to use, slowing down rather than speeding up the encounter process. And, of course, as mentioned, the use of proprietary program data which blocks interfacing with other EMR vendor programs. With virtually any vendor-provider dispute, vendors have the ability to initiate kill switches which can encrypt a provider’s records making it impossible for the provider or the patient to access the record.

Recommendations from NCHI to Congress include developing a method to make IT vendors account for their apparent plan to avoid true interoperability, use Stark laws regarding kickbacks or solicitations for referrals, use HIPAA for establishing the rules for encryption and data, fees, and record ownership.

Let’s hope the rules get real so EMR will become a useful reality. Keep on track with the current trends in healthcare at