EHRs should offer more extensive financial information relating to patients' cost of care to foster transparency between providers and patients, according to pulmonary and critical care physician Walter J. O'Donnell, MD, of Massachusetts General Hospital in Boston.
In an op-ed for STAT, Dr. O'Donnell argued that the type of transparency patients want most is about the cost of care surrounding their physician's orders. However, this information is often unavailable in the EHR, prompting Dr. O'Donnell to question whether it's really the physician's fault when a patient is billed a costly episode of care. He attributes the variety of payers and the companies' different deals with hospitals and pharmacy benefit managers to the lack of price transparency.
Dr. O'Donnell argued that the "primary purpose of today's [EHRs] is financial management, not medical." Despite one of his patient's undergoing an insurance scan before entering the exam room for her appointment, Dr. O'Donnell was still unable to view the patient's out-of-pocket cost in the EHR for a test he ordered because it required a diagnosis for her insurance company, according to the report.
"These electronic systems are good at prioritizing the fiscal health of a medical practice or hospital, while remaining unconcerned about the need of patients and clinicians to avoid — or at least prepare for — big medical bills," Dr. O'Donnell wrote.
Despite his requests for systematic change to "financial toxicity," such as asking administrators to perform basic analysis on medication costs or calling the billing office to protest patients' surprise medical bills, Dr. O'Donnell said change has not been implemented.
"The [EHR] I use contains extensive crosschecking systems to reduce or eliminate adverse drug reactions that might emerge from the prescriptions I write," Dr. O'Donnell wrote. "It can and should offer at least rudimentary warnings to me and my patients about the cost of the tests I order or the medications I prescribe."