A view from the Center

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The EHR adoption debate: Are we missing the bigger picture?

For the past 20 years, each spring, members of the Scottsdale Institute gather to discuss how their organizations are overcoming challenges and retooling for the future. Comprised of some of the best known and most successful health systems and associated industry partners, they are tied together by a common belief that financial success likely depends upon clinical success and achieving high quality, cost-effective care. Transitioning from volume to value is not a distant concept—many are well underway in their transformation, and even more view it as a priority.

Another belief they share is that the evolution of their systems is dependent on data, and that requires a strong foundation of information technology (IT). Many of the Scottsdale members adopted electronic health records (EHRs), implemented clinical data warehouses, and developed sophisticated analytics capabilities early in their journeys. Leveraging these tools, they are tackling some of the most challenging of concepts in health care—accountable care, patient safety, evidence-based medicine, and population health. In short, they are present day glimpses of what the future of health care might look like.

The view of IT as an essential catalyst of progress was a key driver of the American Recovery & Reinvestment Act (ARRA) program to increase adoption of EHRs. The concept seemed straightforward: provide incentives for doctors and hospitals to not just buy, but actually use EHRs. Small groups and community hospitals, historically slow to adopt, would be supported by regional programs to help them through the transformation. And, along with the carrots came some sticks. Barriers to adoption persisted, and resistance was significant, so escalating penalties were established for those who lagged behind.

Despite these barriers, by some accounts, the Meaningful Use Program has been highly effective. The most recent numbers from the Office of the National Coordinator for Health IT (ONC) show 12.2% of eligible providers on track.And, hospitals are not slowing either: in 2012, 3.2 times more hospitals attested than in 2011 (4,802 vs. 1,498 in 2011).However, stakeholders continue to raise concerns that this is too much change too quickly, or that the return on investment doesn’t justify the expense, or that the systems themselves may promote fraud. And more recently, legislation has been introduced that attempts to exempt certain physicians nearing retirement age from penalties for not demonstrating meaningful use, while softening other provisions of the program. On April 16, Senators John Thune (R-SD), Lamar Alexander (R-TN), Pat Roberts (R-KS), Richard Burr (R-NC), Tom Coburn (R-OK), and Mike Enzi (R-WY) issued a report that is highly critical of the MU program and asserts that it is at risk of not achieving its goals or sustainability.3And recently, with budgets tightened amid sequestration, the ONC proposed to collect fees from vendors for certification, which may further impact costs and innovation.

Taken together, these recent efforts have the potential to widen the gap between adopters and non-adopters. Ultimately, while we discuss issues related to EHRs, we miss the big picture. Without a strong foundation of electronic clinical data, we will be less likely to make the crucial transformations in our health system. While the industry drives toward ubiquitous EHR adoption, all viewpoints should have a seat at the table. And, more importantly, we should encourage the industry to look beyond these battles to understand the larger picture—EHR adoption is just one aspect of the uphill challenge we face.

1New England Journal of Medicine, “Early Results of the Meaningful Use Program for Electronic Health Records,” February 21, 2013
2U.S. Department of Health and Human Services
3Senators Thune, Alexander, Roberts, Burr, Coburn, Enzi, “Reboot: Re-examining the strategies needed to successfully adopt health IT,” April 16, 2013


Author bio

As director of the Deloitte Center for Health Solutions, Dr. Greenspun serves health care, life sciences, and government clients on key innovation and clinical transformation issues. He has been named one of the “50 Most Influential Physician Executives in Healthcare” by Modern Healthcare, co-authored the book “Reengineering Healthcare,” and has served on advisory boards for the World Economic Forum, WellPoint, HIMSS, Georgetown University. Prior to joining Deloitte, he served as the Chief Medical Officer for Dell.