Post 2: Healthcare’s Obsession with the “RHE”

There is an apocryphal story about a North America tribe called the ASU that worship an animal known as the RAC. The tribe worships the RAC and considers it sacred; those who don’t own one are held in low esteem.

But RACs are diseased creatures, and maintaining them requires significant resources. RACs also breed at rapid rates, and tribesman pay hefty taxes to maintain public spaces for their use. The excrement of RACs is foul-smelling and useless for fertilizer, and the RAC has a tendency to stampede villages – killing thousands each year.

I first read the story of the RAC in my 6^th grade history class. After we read the story, my teacher asked us to reverse the letters of “RAC” and “ASU.” Immediately, we understood the point of the story.

When sitting in LA traffic, I look forward to the day when cars have been replaced by autonomous electric vehicles with impeccable safety profiles. Nevertheless, I realize cars have tremendous value by enabling us to move about in ways not possible before they existed.

Even more striking is the parable of the “RHE” in healthcare. When I graduated from medical school in 2005, health systems were in the process of transitioning from paper charts to electronic health records (EHRs). A RAND study published that year projected that widespread implementation of EHRs could save the U.S. health system nearly $100 billion annually.

Yet the exact opposite has happened. Formal research and anecdotal experience have demonstrated an “IT Productivity Paradox” – medical providers see fewer patients than they did during the paper charts era. And contrary to predictions that EHRs would improve patient safety (no more errors due to bad doctor handwriting!), evidence on the impact of EHRs on patient safety has been mixed at best (EHR malfunctioning is actually a top cause of medical errors). Perhaps worst of all, patients and clinicians alike report that the computer screen is one of the single biggest impediments to the patient-clinician relationship.

Tragically, our health system continues to worship the “RHE”. I am often told that picking my EHR could be the most important decision we make in starting Starfield Primary Care.

As much as I’d like to do away with the EHR entirely (NB: my wife’s Pediatric practice still uses paper charts and provides the best patient experience of any practice I know), due to compliance requirements it would be very difficult to do so. Additionally, there are major advantages of electronic charts – namely electronically sending prescriptions and tests; communicating electronically with patients through a secure online portal; and seamless online scheduling, to name a few (ironically, online patient messaging and scheduling are some of the EHR functions least utilized by large health systems).