Some thoughts on why the system is broken.
1) The ONC certification process. (https://www.healthit.gov/topic/certification-ehrs/about-onc-...). It is way too complex to explain here, but it started with the incentive program CMS established in 2011 to push doctors to electronic health care records. Like a lot of CMS programs, the intention was there, but so was the opportunity for fraud and abuse. I can't remember the exact numbers, but the amount of certified EHR vendors dropped dramatically between the 2011 and 2014 certifications. The next round (currently 2017 stage 3) will further reduce that number. The 2014 round of certification definitely weeded out a lot of crappy EHR systems that were thrown together and sold to clinics. The problem now is twofold. First, it's becoming so burdensome and expensive to keep an EHR system certified, that only the well-financed (EPIC, Cerner, etc.) can afford to stay in the game. Second, it's extremely expensive for a clinic/hospital to switch EHR systems. Even if you have developed the most amazing EHR system known to man, getting a big hospital or clinic group to switch systems again will be next to impossible.
2) CQM and PQRS/Meaningful Use reporting. It's complicated, time consuming, and expensive. Prior to 2017, doctors were required to report to two different systems PQRS and CQM, both administered by CMS. PQRS has since been replaced by MIPS. Measures that appear to be identical between the two systems (i.e. CMS 69 and PQRS 128) sometimes have slightly different parameters. The measures themselves have versions and can change year to year. The entire system puts a huge financial burden on doctors. I get the intent. It’s the implementation that sucks.
3) Imagine if, on your job, you had to use a system of 70,000 different codes to identify each and every thing you did at work, and you had to justify each and every thing you did with up to 6 different reasons (out of a possible 70,000 reasons), and you had to submit this report each and every day, and if you made any mistakes, or if your reasons weren’t sufficient to justify your work, you didn’t get paid, and you then had to file an appeal to fight it, and it might be several months before you finally got paid. That’s the health care claim system. With the adoption of ICD-10 in 2015, the number of available diagnosis codes went from ~14k to ~70k. The number of Procedure codes went from ~4k to over 70k. If you’re into data analytics you probably had an orgasm. If you are a doctor, trying to get a heath care claim paid, your life got a lot worse. Does it really matter whether a patient got hurt because of a collision with a roller skater (ICD-10 V00.01). Guess what? Your doctor doesn’t get paid if he uses ICD-10 code V00.01. That’s because he has to indicate whether the collision was an initial (V00.01XA), subsequent (V00.01XD), or sequela (V00.01XS). The more complex the system, the more ways insurers can deny claims. It’s easy to get frustrated because your doctor/nurse spends all their time staring at their tablet/laptop clicking away instead of talking to you. Don’t get mad at them. It wasn’t their idea.
To the people who are quick to paint the doctors as greedy, overpaid clerks who can and should be replaced by computer and AI, read this https://www.nytimes.com/2018/05/18/opinion/artificial-intell... . Keep on dreaming about your Elysium/Expanse fantasy where patients are hooked up to a machine and diagnosed/cured. It’s not happening now, it’s not going to happen any time soon. In the meantime, the most effective way for a doctor to treat a patient is to look at the patient, talk to the patient. It’s not reading tea leaves. There are subtle, non-verbal cues that are impossible to pick up if a doctor has his back to you because he/she is forced into a clerical role (see points 1,2,3 above). We are decades away from a computer and AI being able to do this. I hope I am wrong. I watch the Expanse too but it is just science fiction, the key word being fiction.
To the commenters claiming “scribes” can do this. It’s just not that easy. I was involved in developing a scribe system. It worked for a couple doctors. We thought we had the next big thing. The doctors were able to go in and actually talk to and look at the patient while a scribe sat in another room and listened to the conversation and watched a mirror of the doctor’s tablet (all with patients consent). By the time the doctor left the exam room, the progress notes were completed and prescriptions, follow-ups etc. were ready for order. The doctor just had to review and complete. System was great. Doctors were able to go home at a decent hour instead of spending 2 hours in the evening going over each patients encounter. When we tried to expand it failed. In hindsight it was easy to understand why. The scribes we initially used were CAs who had been working with these doctors for years and they could pick up on subtle verbal cues generating complete encounter notes just based on a few comments. In our experiment, it just didn’t work once we brought in scribes who had never worked with or around the doctors. I’m sure there’s a way to make this work and hopefully someone will one day. It would be nice to have a conversation with my doctor again.
Anyway, just some thoughts. I see a lot of posts in here discounting the article and claiming the world is ready for computers to replace doctors, and it’s just the greed/ignorance of doctors holding us back. If you’re ready to put your life in the hands of AI and computers, I wish you the best of luck. I just want a system where doctors can actually be doctors again. The greedy people in our health care system don’t wear white coats. They run around with titles like “Hospital Administrator”, “Pharmaceutical Rep”, “Health Care Lobbyist”, “Senator/Congressperson” and “Insurer”.