Electronic Health Records: a murderous, publicly subsidized, $13B/year grift by way of shitty software

In 2009, the bipartisan HITECH Act pledged $36 billion to subsidize the adoption of Electronic Health Records throughout America's fragmented, profit-driven health system, promising that the system would modernize American health care, save $80 billion (and countless lives), and deliver a host of other benefits; a decade later, the EHR industry has blossomed from $2B to $13B, and adoption is up from 9% to 96%, and it's a catastrophe.

Part of the problem lies in the structure of the HITECH Act itself: it created incentives for practices to buy "certification" EHR tools, but that certification was incredibly lax and allowed all kinds of terrible, buggy code to attain certification. The cash incentives were so great that companies poured fortunes into luring doctors to banquets where they were instructed on how to maximize their government subsidies, but the certification process did not protect doctors from unscrupulous vendors.

Importantly, a certified tool did not have to be standards-based, meaning that there was no requirement that patients be able to move their records from one practice to another (this is a feature, not a bug: the medical industry's term for a patient switching practices is "leakage," and the incompatibilities in rival practices' EHR tools were an excellent hedge against it, serving as a lock-in for patients). What's more, certified vendors were allowed to bind the healthcare providers to nondisclosure and nondisparagement clauses, making it illegal for them to warn other doctors about defects in EHR products.

To top things off, the HITECH Act did not establish any kind of FDA tracking system for complaints about bugs in EHR tools -- even bugs that maimed or killed patients. Read the rest