When President Obama was trying to sell Obamacare, an oft-touted reform was electronic health records. EHRs were second only to "If you like your health care you can keep it" as a selling point for better, less expensive medical care. EHRs would empower patients and make information more readily available to physicians. What could go wrong?

Plenty–doctors aren't sold on ehrs. To be fair, ehrs were being heralded as a way to improve medical care before President Obama came to office. But an article in Technology Review, which is published by MIT, points out that the Obama administration put or our money where its mouth was:

[T]he Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn't had much more luck getting physicians to change their ways.

The electronic health records craze may turn out to be yet another case of government overreach. Bureaucrats may have once again sold a clever plan that doesn't work in real conditions. It does sound good to many people, and doctors, left to their own devices, may one day come to adopt a version of the plan. But right now most of them don't like it.

Even with the government's subsidy, most doctors are turned off because the technology necessary for ehrs slows productivity (it was supposed to do just the opposite), requires doctors to reorganize their practices, shows negative return on the investment, and distracts doctors from the actual patient. The government stimulus, as it turns out, is practically irrelevant:  

It is not only the $40,000 that software vendors charge to install an electronic records system and the $10,000 to $15,000 for annual maintenance. It is the hassle factor and the often prohibitive cost of hiring staff to enter the data and to comply with new rules and regulations. When added to the time and effort already required to deal with Medicare, Medicaid, and health insurance plans, EHR requirements are the final straw. Many doctors are seeking refuge from bureaucratic demands by retiring, closing practices to new Medicare and Medicaid patients, or seeking hospital employment.

The article is by a physician, Richard L. Reece, and he doesn't dismiss the possibility that physicians will one day embrace ehrs–but it has to be something that develops from the practice of medicine, not an idea that sprang full blown from the mind of a bureaucrat:

[M]any physicians believe that new apps, such as better speech recognition or systems that translate data into narrative, will make EHRs easier to use. "Free," government-subsidized, or cheaper models will enter the market; clinical algorithms, based on demographic and patient-entered historical information, will make diagnosis, treatment, and management faster and better. But these features must evolve from below rather than being imposed from above. EHRs won't be useful and physician-friendly until physicians themselves have more input into their design.

I can't help thinking that the government's overestimation of the immediate value of ehrs may reflect the critical flaw of Obamacare: it is a system built on the ideas of bureaucrats, not on the day to day practice of the healing art. Obamacare doesn't take into consideration the all-important relationship between doctor and patient. As Dr. Reece writes:    

A string of numbers containing demographic, laboratory, and other patient information, no matter how systematically assembled or gathered, is not narrative. It does not tell a story. It contains "just the facts," as Sergeant Joe Friday used to say. That is why an ophthalmologist told me that when he gets an EHR summary, he ignores it: "It does not tell me the patient's story. It does not tell me why the patient is here, what troubles the patient, and what the referring doctor wants me to do."