Fraudulent billing. Identity theft. Greater expense and inefficiency. Loss of privacy. And campaign donations from the companies benefiting most.
Electronic medical records (EMR) came into mainstream consciousness after a hardcore lobbying effort by the EMR industry. The result? A $19 billion (yes, that’s billion with a B) government incentive package was built into the 2009 economic stimulus bill just for electronic medical recordkeeping.
This package benefits the three largest EMR companies the most. The annual sales of Allscripts have more than doubled, going from $548 million in 2009 to $1.44 billion in 2012. Cerner’s sales increased 60% in the same period. Epic doubled its revenue to $1.2 billion from four years ago, making its founder a billionaire.
That EMR companies should be so favored will come as no surprise when you learn that the then-CEO of Allscripts, Glen E. Tullman, was the health technology advisor to the Obama campaign in 2008. In 2009, before the stimulus package was finalized in 2009, he visited the president at least seven times as Allscripts CEO, and personally donated over $225,000 to the campaigns of legislators like Sen. Max Baucus (chairman of the Senate Finance Committee) and Jay D. Rockefeller (chairman of the Commerce Committee).
Judith Faulkner, a controversial figure at the center of the electronic records mandate, is described by columnist Michelle Malkin as “[President] Obama’s medical information czar and a major Democratic contributor [who]just happens to be the founder and CEO of Epic Systems—a medical software company that stores nearly 40 percent of the U.S. population’s health data.”
In December 2008, the chief executive of an EMR trade association wrote an open letter to Obama calling for government investment of at least $25 billion to adopt EMR. The government ponied up $19 of the requested $25 billion.
Despite all the government funding, EMRs haven’t lived up to the promise of lower cost and increased efficiency—something we predicted back in 2009. On the contrary, the new approach seems to be increasing costs through overbilling. Electronic recordkeeping makes it easier to overbill for services. For example, the percentage of the highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010—one year after it began using a software system for its emergency room records. In general, hospitals that received government incentives to adopt EMR showed a 47% rise in Medicare payments from 2006 to 2010, compared with a 32% rise at hospitals that did not receive any government incentives.
Fraud is a huge problem with EMR. Some EMR programs can automatically generate detailed (but fake) patient histories, or allow doctors to cut and paste the same examination findings for multiple patients (a procedure called “cloning”) so it looks like they conducted far more examinations than they actually did. Doctors can also click a box indicating that a thorough review of patients’ symptoms had taken place, even though the exams Medicare is paying for were rarely performed.
Dr. Donald W. Simborg, who was the chairman of federal panels examining the potential for fraud with electronic systems, said, “It’s like doping and bicycling. Everybody knows it’s going on.” The Office of the Inspector General is studying the link between electronic records and billing.
While creating a nationwide records database might seem at first glance to be a good idea, the whole EMR policy was implemented quickly without anyone doing a careful study of potential problems. Patients and and their health records have become guinea pigs in the EMR experiment.
There are many serious difficulties with EMR, even outside of the fraud issue. Doctors have complained that the system is very time-consuming and inefficient. It can actually increase rather than decrease required paperwork. They say in addition that it’s not tailored to physicians’ needs, but instead fits the more narrow vision of Washington bureaucrats. Technological glitches and human errors have, for example, resulted in the wrong prescriptions being issued. Privacy issues make it difficult to get reliable data on EMRs, but it is estimated that EMRs will be linked to at least 60,000 adverse events. There is no industry standard of liability if a patient is harmed by EMR software problems.
In addition, computerized systems are vulnerable to crashes, and the larger the system, the greater the crash. Networking between EMR systems even within the same hospital system can be problematic. The internationally respected Mayo Clinic, which treats more than a million patients a year, has serious unresolved problems after working for years to get its three major electronic records systems to talk to one another, according to the New York Times. The technologies of different service providers—say, between the hospital and pharmacy—may be incompatible.
Even more worrisome, the EMR system is ripe for medical identity theft, as we reported two years ago—a problem that will affect an estimated 1.49 million people in the US, at a cost of $41.3 billion. And since the healthcare system is so fractured, it often requires going from hospital to hospital to get a billing problem resolved—something that can take years. Privacy issues complicate matters further: victims and their families sometimes can’t get files from doctors to clear up the issue. Most medical facilities simply don’t have policies in place to deal with medical identity theft.
Bloomberg reported the story of Arnold Salinas, a 53-year-old maintenance worker whose identity was stolen when someone took out medical care in his name. He’s been fighting his case since 2002, and fears his valid medical records will get mixed with the thief’s, possibly leading to dangerous confusion.
In 2009 we were promised that the EMR system would “cut waste, eliminate red tape and reduce the need to repeat expensive medical tests…it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing…medical errors.” None of those promises have come true. The government, pushed by special interests, has rushed through an EMR system that costs American taxpayers more and makes our medical records—and possibly our health—far more vulnerable.
As we noted in 2011, allowing hundreds of thousands of parties to access your records, including mental health and other sensitive information, is by definition a serious invasion of privacy. When you apply for a government job, they ask you if you have seen a psychiatrist in the last five years. People who need help may be reluctant to seek it with their records available to the whole world. If everyone’s records are open for others to see, who will confide to their doctor anymore?