EMRs in U.S. hospitals

The rate of adoption is low. Very, very low according to survey data published in the NEJM. The paper is available as free full text here.

An accompanying editorial, also freely available in full text, is an important and educational read for those unfamiliar with the health care provisions of American Recovery and Reinvestment Act of 2009 (ARRA), the recently passed stimulus bill. The editorial focuses on the information technology piece of the bill, known as the Health Information Technology for Economic and Clinical Health (HITECH) act. It provides strong financial incentives to doctors and hospitals in the form of subsidies for timely adopters and penalties for non-adopters. One of the more concerning provisions is that providers must have “certified” EMRs and that the use of said systems must be “meaningful.” While these terms await better definition most would agree that one requirement will be interoperability by which EMRs of different facilities are somehow connected. How is that supposed to work? In my locale I can think of six large facilities with EMRs, all from different vendors, none of which talk to one another. What type of infrastructure will need to be put in place to accommodate interconnectivity of these systems? What types of upgrades will be needed? Will some systems have to be dismantled and replaced with “certifiable” systems? The editorial addresses this issue:

Second, much will depend on the federal government's skill in defining two critical terms: "certified EHR" and "meaningful use." ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT. Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients. By tying Medicare and
Medicaid financial incentives to "meaningful use," Congress has given the administration an important tool for motivating providers to take full advantage of EHRs, but if the requirements are set too high, many physicians and hospitals may rebel — petitioning Congress to change the law or just resigning themselves to forgoing incentives and accepting penalties.

I suspect these concerns will delay adoption of EMRs by some health systems, pending clarification of system requirements for certification.

The editorial ends with:

The nation's economic woes have given birth to an unprecedented federal effort to modernize the information systems of a troubled health care system. It is now up to the government and the nation's health care professionals and facilities to turn this opportunity into real improvements in the health and health care of Americans.

That’s optimistic. It may be decades before the EMR improves our nation’s health. It’ll be one thing to develop a really good system nation wide. An even greater challenge will averting and fixing the adverse consequences of the new culture that will surround adoption of electronic health records.