The Rocky Road of EMR Adoption in the U.S.

It was billed as the future of health care — a system that electronically captures all relevant patient data. A system that clinicians across multiple disciplines could seamlessly access and update in real time to provide a more efficient and effective continuum of care. It’s true, electronic records have significantly improved many aspects of health care. But some predictions of a fully integrated health care system remain unfulfilled. Has the movement toward an electronic system delivered on its promises, or did reality fall short of expectations?

First, we need to understand the difference between electronic medical records (EMRs) and electronic health records (EHRs). The two terms are often used interchangeably, though they have different meanings. EMRs are simply the digital form of the paper charts in a specific clinician’s office. EMRs track data over time including medications, treatments, and test results. They can also help with scheduling prevention screenings and checkups. But EMRs come with one significant limitation in that they often don’t function beyond the individual practice. Many patients require coordinated care between different specialties. In these cases, EHRs allow different clinicians from different practices to access a patient’s data. For example, a specialist can see lab results ordered by a primary care physician. Or a physical therapist can understand the scope of a patient’s injury by viewing their surgical history.

The rapid adoption was sparked by government intervention.

Both EMRs and EHRs have become standard practice for individual offices and health care systems across the country. The CDC reports that 86.9 percent of office-based physicians use some form of EMR or EHR system, compared to less than 25 percent a decade ago. Cardiologists and neurologists have the highest adoption rates (95.6 percent and 94.5 percent respectively), while dermatologists and psychiatrists are the least likely to use EHRs (70.2 percent and 61.3 percent respectively). The general trend toward adoption is encouraging considering nine out of 10 U.S. doctors updated patients records by hand and organized them in color-coded files roughly a decade ago.

Why such a dramatic change? The rapid adoption was sparked by government intervention. The American Recovery and Reinvestment Act of 2009 included $19.2 billion allocated for health information technology to help clinicians and hospital systems implement EMRs and EHRs. Health care providers had until January 1, 2014, to not only convert to electronic records, but also prove the conversion was successful by documenting and demonstrating “meaningful use.”

“Meaningful use” is defined in two stages. Stage 1 meaningful use requires clinicians to primarily capture patient data. For example, health care providers would record a patient’s vital signs, medical history and medication lists. Stage 2 sets higher benchmarks around sharing the data between clinicians, and between clinicians and the patient. The ultimate goal of this two-stage process is to achieve the Triple Aim of health care: Improving patient experience, reducing health care costs and improving patient outcomes.

The needs of the EHR system depend on the current stage of the system’s lifecycle.

But simply adopting the technology doesn’t guarantee systems-wide improvements.  A few potholes exist on the road to a fully integrated electronic system. While many clinicians complain about poor usability of EHRs, one 2013 study identified five specific barriers to full implementation:

  • EHR products are often expensive. Even after the initial technology investment, health care providers must spend to update, maintain and troubleshoot the technology.
  • EHR applications aren’t standardized. As different clinicians work in different electronic formats, interoperability becomes more of a challenge.
  • EHRs are more difficult to use than paper-based records. There is a simplicity to writing exactly what you want to convey that electronic records have not yet emulated.
  • Initial implementation of EHRs disrupts workflow and reduces practice productivity. While EHRs will eventually drive efficiencies, clinicians must climb a steep learning curve. The initial loss of productivity to learn a new system may be daunting for many health care providers.
  • Patients and payers gain the most benefit from a system that health care providers must implement.

These challenges are also reflected in satisfaction surveys, as 67 percent of respondents are dissatisfied with the functionality of their current EHR system.

Still, one health care consultant compared EHR implementation to raising a child. The needs of the EHR system depend on the current stage of the system’s lifecycle. For example, the “newborn” stage of stabilizing the EHR system after the initial launch requires a vastly different set of resources than the “teen years” of ironing out efficiencies to achieve the Triple Aim. It’s an interesting argument that reframes how we might think about investing in these systems. Health care providers can’t afford to simply drive toward EHR adoption, but instead aim for continued investment to ensure the system reaches its full potential. In other words, electronic medical records weren’t truly the future of health care. They were merely the beginning.

This piece was published to commemorate National Health IT Week, October 2nd- 6th, 2017. National Health IT Week was founded by the Healthcare Information Management Systems Society (HIMSS) in 2006. As a HIMSS approved education partner, HealthInformatics@GW is committed to helping raise awareness about the value of health information technology. For more resources on health IT, follow us on Twitter @GWSPHonline, or check out the National Health IT week website.

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