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In EHR Adoption, Patience is a Virtue

A recent RAND study featured in the January issue of Health Affairs suggests that we are slow to achieve the cost-savings promise of health information technology. Authors suggest this is because the systems are not used widely enough, interconnected or fully embraced by the physicians who use them.

It’s true that U.S. healthcare hasn’t achieved the savings predicted by groups like RAND themselves (whose models were over-aggressive and questioned at the time by experts in the Congressional Budget Office). But the recent study still concluded that adoption presents the potential to save more than $80 billion annually. 

Unfortunately, like the first RAND study published in 2005, this one takes the complex issues challenging healthcare providers, software developers and regulators alike and boils them down to simplistic analysis that ignores the size of the change we are collectively affecting here.

Big changes take time

Did you know that blood-letting persisted into the 20th century as a common medical treatment despite the fact that doctors were questioning the basics of the practice as far back as the early 1600s? In fact, George Washington died after being bled in response to a persistent sore throat!  And yet, physicians promoted the practice of blood-letting to treat everything from acne to diabetes to migraines for centuries because the fact is, bad habits are hard to break. Sound like any bad habits that a few of today’s providers might be stuck on?  Such as using paper records?

Authors of the RAND study indicate that adoption rates have been slow. While rates are uneven across segments of the market, with rural environments and small independent physician practices moving more slowly than others for varying reasons, overall adoption has actually risen at incredible rates since the passage of the HITECH Act. According to the CDC’s December 2012 report, 71.8% of ambulatory physicians used EMR/EHR (electronic medical record/electronic health record) systems in 2012, up from 48% in 2009. 

The kind of change we’re talking about is significant. It involves noteworthy product changes by the vendor community. It also requires comprehensive adjustments on the part of the providers involved – in how they use the software, interact with their patients and report on their behavior.  But again, moving from 48% adoption to 72% in just three years simply cannot be described as slow.

Reengineering care takes time, too

Even after a provider has moved forward with EHR adoption, there are some who cling to their old paper-based processes and don’t embrace the full potential of their EHR or get the training they need after they’ve implemented one.  I understand that – change can be hard for anyone. This is, however, a real challenge for the industry.  Working to change that behavior is important, too.

Primary care physicians who receive more technical assistance when using EHRs are  more likely to achieve care quality improvements than physicians who receive little or no technical assistance (see Weill Cornell Medical College news).  Those providers who try to take their paper process and simply drop that into an electronic workflow are going to find themselves frustrated and falling short of care improvement goals.

That said, most of our clients recognize that the new technology, while at first disruptive, ultimately helps them provide indisputably better care once they are proficient. Examples of people who appreciate the change outpace those who reject it (see videos from our recent client conference).

For example, physicians at the 972-bed Bronx-Lebanon Hospital Center in New York City used technology to reduce their patients’ average lengths of stay (ALOS). In an interview with Healthcare Informatics, the hospital credits technology with helping to achieve a 1.8 day reduction in length of stay in just five months.  That’s not only good for patients but good for the nation’s pocketbook.

Lack of prolific data exchange

Most agree that much of the healthcare cost savings that can be facilitated through health IT adoption will come from information exchange between providers, and that we need to see more of it.

Authors of the RAND study suggest that interoperability can be achieved with better IT systems. Unquestionably, EHR systems must store data in such a way as to be easily retrievable and transmittable, and the Stage 2 requirements around transport mechanisms will advance the collective industry in only a matter of months. 

However, even where our clients want to exchange information (and we have many doing it already), several systemic obstacles still exist. 

  1. The fundamental reimbursement models in our country don’t currently encourage providers to cooperate with others in their area because they’re paid based on volume, rather than collaborating to improve patient care.  Thankfully, we are making good progress towards new payment schema that focus on the quality of care, rather than only on the quantity of patients.
  2. State-level legislation and regulations around privacy and security are inconsistent and many times, in direct conflict with one another.  In most cases, patient information doesn’t flow across state lines even when patients do.
  3. Patient identification remains a valid concern among clinicians.  While the idea of a National Patient ID remains a political third rail, there are secure alternatives with significant industry backing, such as patient matching technologies.  It shouldn’t be surprising that physicians want to feel secure that the data they are attributing to John Jones actually belongs to that John Jones.
  4. And most importantly, we do not have the infrastructure we need to exchange information easily and cost-effectively despite the fact that hundreds of millions of dollars have flowed to the states to build that pipeline for data – several years in, Health Information Exchange (HIE) is just getting started with any real momentum, and it will take continued support by the states, regions and municipalities – even as ONC funding runs out soon – before we can make even better progress.

In the end, let’s remember: Its only been two years since the Meaningful Use program began paying incentives. That’s a blip on the screen of medicine and healthcare. Drastic and disruptive changes take time. And it’s worth the wait. 

What do you think about the RAND study featured in Health Affairs? Do you agree or disagree?

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About the author

Leigh Burchell directs the Policy & Government Affairs function for Allscripts, including legislative advocacy and regulatory interpretation and comment. She advocates not only for the interests of the software development community but also the company's 180,000 physician clients, 2,500 hospitals and 17,000 post-acute organizations. Burchell is also active in many industry associations, including the Electronic Health Record Association (EHRA), where she serves as Chair; the eHealth Initiative, where she sits on the Leadership Council and the Policy Steering Committee; and HIMSS, where she is Vice Chair of the HIMSS Public Policy Committee.

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