HIT Think

Why EHR implementation is only half the battle

The adoption of electronic health records technology over the past decade is one of the best feel-good stories for the healthcare IT industry.

This past week, the Office of the National Coordinator for Health IT reported soaring percentages in tracking the adoption of EHRs by U.S. non-federal acute care hospitals. Announced in conjunction with its annual meeting in Washington, D.C., the survey reported that adoption of basic EHRs increased to nearly 84 percent of hospitals. As recently as 2010, only 16 percent of U.S. hospitals had this technology in place.


That’s good news, and ONC notes that it’s more than just having systems installed and gathering dust. It sets certain parameters for what it considers adoption, which include having required functions in place and having those functions used by professionals.

Data also indicate that physician practices have installed and are using EHR technology, with even more dramatic increases in percentages over the same span of years.

Adoption has come at great cost over the past six years; the federal government has spent more than $30 billion on incentives, and the healthcare industry has spent multiple times that amount to invest in technology. That doesn’t take into account the manpower required to install the system, teach others to use them, and the challenges the technology have imposed on medical practices during the learning phase, and beyond.

While those percentages regarding adoption are positive developments, other data and reports cause concern about the real value of having these systems in place. Is it possible that the rush to implement EHR systems has missed the mark, and the achievements represent a Pyrrhic victory, in which the victory yields too few results at too high a cost?

A second survey by ONC released last week shows that while organizations have EHRs in place, those systems appear to be operating in silos. Interoperability, while increasing throughout the industry, still remains at low levels.

The percentage of hospitals electronically sending, receiving and finding key clinical information grew between 2014 and 2015, ONC data show. But the use and integration of this data from one organization’s system into another’s remains relatively low.

“About 4 in 10 hospitals had the capability to integrate data into their EHRs without manual entry,” ONC reported. Further, only 18 percent of respondents to the interoperability survey say they often use patient health information received electronically from outside providers when treating patients, and another 35 percent say they sometimes use others’ data.

To a degree, that’s a reflection of the difficulty of finding that information and getting it at the optimal time in a care professional’s workflow. With the fast pace of care delivery today, clunky data exchange isn’t helpful. As healthcare moves to reimbursement models that will demand more care collaboration and coordination, this current reality reflects a low level of reliance on others’ electronic data.

Late last week, the nation’s physicians called on federal regulators to up the nation’s ability to exchange information, not settling for low-level interoperability requirements reflected in past iterations of meaningful use.
On Friday, the American Medical Association and 36 specialty medical associations urged the Administration to rethink the way it measures the interoperability of EHRs. The coalition contends the current direction requires physicians to spend too much time meeting measures that do little to make EHRs valuable to patients and medical practices.

“The lack of interoperability is one of the major reasons why the promise of electronic health records has not been fulfilled,” said AMA President Steven J. Stack, MD. “Vendors have been incentivized to meet the flawed benchmarks under the Meaningful Use program. We need to replace those benchmarks with ones that focus on better coordinated care. MACRA offers that opportunity, and we need to take advantage of it.”

The coalition’s letter contends that the vast majority of vendors offer products that simply exchange static documents, thus satisfying the bare minimum requirements for MU. “Many in healthcare view this level of exchange as little more than digital faxing,” the letter said, urging new ways to assess whether records systems are achieving useful interoperability that assists care.

Many in the healthcare IT industry have talked about the need to optimize the use of EHRs, to not just stop at implementing systems but to really derive value out of them. Perhaps a broader view of optimization is required, expanding it to include data exchange that really makes an impact on patient care across organizations, and not just within one delivery system.

I sometimes equate this journey to that experienced by second language learners. When people learn a new language, the first level they achieve is learning enough to survive in a new culture; some students progress on to higher levels of language proficiency, but then tend to “fossilize” at some point (getting stuck at a level of proficiency) because other priorities tend to crowd out the hard, difficult, time-consuming work of achieving true fluency.

With all the investment in digital health systems, and all the toil that’s gone into the transition, it’s no time to fossilize at the current level of interoperability. While hard work lies ahead to achieve it, there’s a desperate need for the fluency that true interoperability can provide.

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