Electronic health records could hurt small clinics

Electronic health records are all the rage, but their unintended consequences have negative effects on the citizens of Minnesota.

In "What you tell your therapist goes online?" (March 23), Dr. Peter Zelles accurately emphasized that intimate psychological and even financial data would be available far and wide for discovery and misuse. Hacking is a routine event in our world now. Privacy is a dangerous illusion.

There is another effect that has been profound: the disappearance of smaller, more personal independent clinics.

The Minnesota Legislature in 2007 made electronic health records (EHRs) mandatory for physicians' offices. Since these systems cost tens to hundreds of thousands of dollars per physician up front, and tens of thousands more for annual updates, they are too expensive for small groups. This is the single largest reason for the extreme consolidation of health care into large corporate systems in Minnesota since 2007.

Witness the almost complete disappearance of independent, local primary care clinics in the Twin Cities. (Some call our new reality "big-box care.") Rather than go out of business, small groups have no choice but to be merged into ever-larger systems with deep pockets, systems that have far different priorities and service styles than small clinics. Some patients may prefer this, but most of us probably prefer having the option of more personal care in smaller clinics.

Since health care is data-intensive, EHRs hold promise for the future. But that future is a long way off. The chief purported benefit is interoperability: the ability to connect with other health care providers' computers to share data and reduce duplication and errors.

There are 50 or more separate vendors of EHRs in Minnesota now, and none of them offers interoperability — i.e., they can't "talk" to one another. Even one of the largest manufacturers, Epic, has EHRs that can't communicate with other Epic products within the same block in town. There are no standards for interoperability, so they are all different.

Physicians know many other negative side effects of EHRs, including degrading information into box-checking instead of description, distracting physicians from looking at the patient instead of the computer screen, reducing time to see more patients because of the inefficiency of data entry, "locking in" incorrect data — all adding to the problems of data insecurity and overwhelming cost.

Why is government so set on this mandate? Because it wants to mine your data for public health information. But for the physicians who have to use these systems every day, who judge their potential on patient needs rather than pleasing Big Brother, the negatives at present are too great.

Physicians should be in charge of their EHR decision. As I write this, the Legislature is considering bills that would exempt small practices and delay the mandate for several years until interoperability is feasible. We can only hope legislators listen to reason and act judiciously.