GAO Report on Electronic Health Record Access is Seriously Flawed

The Government Accountability Office (GAO) recently released  a report entitled “HHS Should Assess the Effectiveness of its Efforts to Enhance Patient Access to and Use of Electronic Health Information” (GAO 17-305). This GAO report is supposed to hold the Department of Health and Human Services (HHS) accountable for delivery of the Medicare and Medicaid EHR Incentive Program (also called the Meaningful Use program) goals. The Medicare and Medicaid EHR Incentive Program began in 2011 and dispensed $35.9 billion taxpayer dollars (as of February 2017) to 517,000 private healthcare businesses (doctors and hospitals) to “adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified EHR technology”.   The problems with the program boiled down to the fact that even though doctors and hospitals were “offering” Electronic Health Records, patients are not using them as shown in the graphic below taken from the GAO report.

GAO report on EHR access results

The GAO report was meant to accomplish the following three goals:

  1. Describe the extent and type of electronic access to health information currently available to patients, and patients’ views about this access
  2. Describe the extent to which patients electronically access their health information, and actions providers reported taking to encourage such access
  3. Evaluate the Department of Health & Human Service’s (HHS’s) efforts to advance patients’ ability to electronically access their health information.

Unfortunately, the GAO data used to evaluate and make recommendations in this report was built on faulty assumptions perpetuated by the design of the Meaningful Use program.  Let me explain.  To accomplish the first two objectives, the GAO did a literature review of 51 articles published from 2014 to 2015 and analyzed the data collected from doctors and hospitals who “self reported” about the meaningful use of the Electronic Health Records (EHRs) in their possession. From this group, they also interviewed 175 hospitals/ 253 healthcare professionals in the Meaningful Use program in 2014 who came forward.  The GAO also consulted with countless agency officials, health IT experts (who make money selling the certified EHR software to doctors and hospitals), and experts in various other organizations.  The number of direct patient interviews came from 33 Americans, who answered the GAO’s call on the patient’s website, PatientsLikeMe to share their experiences with their shareable Electronic Health Records.  I regret that I  hadn’t seen this call (not being one of the 500,000+ advertised subscribers) since I would have gladly given them my observations.  The GAO’s faulty assumption is that direct patient information doesn’t matter.

The GAO makes one big error in its report– it assumes that doctors, hospital representatives, and various experts, who make money in the healthcare industry (and therefore have vested interests in their answers) speak for the patients they serve. The  researchers at the GAO made the untested assumption that “self-reported” information from doctors and hospitals accurately reflects the conditions seen by patients. Neither the GAO nor the Department of Health and Human Services (HHS) that runs the Meaningful Use program made any real attempt at getting information directly from the people who will potentially benefit from the Electronic Health Records; namely, the patients.  There are plenty of reasons to doubt the “self-reported” data if the researchers had only asked patients (more than 33 would have been nice) the right questions.

gao report does not ask patients for input on EHRs

I am not a GAO researcher nor am I considered an expert in the field of Health IT,  but I can recognize a simple statistic on a infographic on the government’s HealthIT.gov website  that I think the GAO should have consulted before narrowing their investigation to the point where they cannot see the forest for the trees. A part of the infographic is reproduced below.

data not considered in GAO report

The two statistics circled above are red flags that should have stopped the GAO researchers cold. I am surprised that only 27% of individuals were unaware or didn’t believe they had a right to an electronic copy of their medical records. Over the past fifty years, doctors and hospitals made it very difficult for patients to get any health records.  Many doctors believe that the health records are belong to their businesses.

The second statistic is even more troubling because it tells us that a large number of Americans are not seeing their health information—in any form, electronic or analog. How does this statistic jive with the following descriptions from the GAO report?

“Our survey found that nearly all providers routinely provided new patients with access to this information (92 percent of health care professionals and 91 percent of hospitals).” (from the 2014 Medicare EHR Program survey)

“In 2015, all participating hospitals and nearly all participating health care professionals reported offering electronic access to health information to 88 and 87 percent of their patients respectively, on average. This means that the providers gave the patients they saw or discharged all of the information necessary to electronically view, download, and transmit the patients’ health information, such as a website address, a username and password, and instructions for logging onto the website.

In reality, patients are lucky if the personnel in a doctor’s office even ask “Are you interested in getting Electronic Health Records?” To a healthcare business wanting to maximize its income and profits in the short term, EHRs represent a cost that can be minimized if fewer patients take advantage of it. Discouraging patients from signing up for EHR access therefore makes business sense.   I would like to see the answers given by patients who were directly contacted (e.g., via email obtained from a doctor’s or hospital’s records) and asked the following question:

Were you given all of the information necessary to electronically view, download, and transmit the patients’ health information, such as a website address, a username and password, and instructions for logging onto the website?

Asking patients this question directly could put HHS in a politically difficult position and question the entire foundation of “self-reporting” by doctors and hospitals within the Meaningful Use program.  I can predict the results would be very different from the rosy “self-reported” answers given by doctors and hospitals speaking for their patients. The truth often hurts.

In addition, both HHS and the GAO personnel work on the assumption that the doctors and hospitals would fully inform and educate patients on the use of the shareable Electronic Health Records–records that had to be thrust down their throats even with $35.9 billion in taxpayer funds to sweeten the deal.  Is this thinking naivete or sheer indifference?  How did these agencies think that patients were going to get informed–through osmosis?

Summary: GAO Report on EHR Access is Seriously Flawed

The GAO report described above is seriously flawed because it does not acknowledge two fundamental issues —

  1. The GAO and the Department of Health and Human Services (HHS) assume that doctors and hospitals can speak for their patients when it comes to Electronic Health Records.  They are wrong!  Doctors and hospital representatives speak only for private healthcare businesses whose primary goal is maximization of income and profits. Patients need to be heard directly!
  2. the need for educating patients about Electronic Health Records goes unrecognized and unfunded.

There is a large gulf between what patients are experiencing and what is being “self-reported” by the people who make money in the healthcare industry, Until HHS and the GAO acknowledge this fact, they will never get a true picture of why so few patients access their Electronic Health Records.

In addition, it is obvious that the Meaningful Use program spent little money on educating the public about Electronic Health Records and their benefits and the result is that the majority of patients are clueless.   The need for patient education should have been center stage in the GAO report recommendations. Putting copies of videos and creating infographics on a largely unknown website access does NOT get the word out.

Additional Reading

My First Electronic Health Records ,  June 2, 2016
Meaningful Use: The Pretend Program,  June 8, 2016
My Electronic Health Records Observations—2012 to 2016,  June 20, 2016
 Health Information Blocking—Example 1,  July 1, 2016
Meaningful Use Program Scam or Business as Usual?,  July 31, 2016
Meaningful Use Self-Attestation—License to Steal Taxpayer Money?,  August 1, 2016

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