Current Generation of EHRs Impeding Healthcare's Volume-to-Value Transformation

Michele Warg
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In 2005, the RAND corporation predicted that electronic health records would help reduce U.S. health care costs by $80 billion per year, notes Scott Wallace, writing for Modernhealth care. In 2013, the think tank revoked the claim, an act that served as an indirect sign of the challenges that the current generation of electronic health records has created in the health care industry.

Electronic health records are often touted by pundits as a critical tool in the race to transform the U.S health care system, which tends to attract criticism for inefficiency, poor outcomes and high costs. According to, some of the benefits of electronic health records include a reduction in costs partly due to minimized paperwork, improved patient record security, reductions in misdiagnoses and easier sharing of patient records between health care providers. Electronic health records are also framed as a way of helping health care providers cope with the shift from volume-based to value-based reimbursements.

Unfortunately, rather than aiding it, the current generation of electronic health records impede the transformation of the health care system, argues Wallace. The system is mired in a volume-centered paradigm; it is better at collecting billing information than aggregating and reporting information in a way that would help health care providers offer better care. Ninety percent of nurses interviewed in a study cited by Wallace reported that electronic health records made communication with patients more difficult.

The current generation of electronic health records may also increase inefficiency. A study conducted by Dr. Stephanie Woolhandler and Dr. David Himmelstein and cited by Wallace showed that doctors who use electronic health records spend a larger proportion of time on administrative duties compared to their paper record-wielding counterparts. A survey conducted by the American Medical Association and cited by the RAND corporation echoes those sentiments, with many doctors finding the current generation of virtual health records cumbersome.

Fortunately, these and other problems with the existing generation of electronic health records can be solved. According to Wallace, makers of these systems should learn from companies such as Amazon that design intuitive software. Systems should be crafted around patients and care providers, not billing organizations.

Health care providers such as the Cleveland Clinic and Iora Health are proof that electronic health records can aid, not impede transformation. The organizations have structured their electronic health record systems around health care providers, making their work much easier. Doctors can, for example, view several patient records without having to constantly log in or out. Iora Health, a health care provider based in Boston has a system so intuitive that neophytes can learn to use it in less than one hour.

According to Dr. Mark Friedberg, a scientist who works at the RAND corporation, a substantial majority of physicians recognize the benefits of electronic health records. Unfortunately, the drawbacks of these systems are a significant impediment to their work. However, organizations such as Cleveland Clinic and Iora Health have shown that, when these systems are properly designed, electronic health records can be a pleasure to use.


Photo courtesy of ddpavumba at



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