Few governmental policies have been as intrusive and disruptive as the 2014 Health Information Technology for Economic and Clinical Health Act (HITECH) which mandated the adoption of interoperable electronic health records (EHRs). HITECH incentivized the integration of EHRs by rewarding adopters with $63,750 in maximum Medicaid payments, and penalized organizations between one and three percent of Medicare payments for refusal. According to a 2014 Health Affairs study almost 78% of physician practices used some form of EHRs in 2013, while 48% utilized EHRs with advanced functionality. Hospitals are lagging behind with 59% using some form of EHRs with advanced capabilities. While the statistics appear to indicate widespread adoption by physicians and healthcare organizations, there is a hidden component to the changing medical landscape. A study by Accenture found that almost 53% of physicians surveyed are leaving private practice because of the requirement to adopt health information technology. Many of these physicians are entering early retirement or folding their practice into a larger accountable care organization that can better manage the transition to EHRs. Other healthcare professionals are also struggling with health information technology adoption. A 2014 Loyalty survey of 13,650 nurses reported that 85% of respondents struggled with inadequate EHR systems, and only 26% supported the belief they improved patient care. Many nurses have expressed dissatisfaction with the systems chosen by their hospitals, which are often selected for lowest cost rather than effectiveness. However, it should be noted that this may also be a generational issue with more technology proficient younger nurses more amenable to the usage of EHRs. Among the primary reasons there is so much resistance to health information technology is that, for the most part, these technologies have not matured enough. While many healthcare professionals recognize the need for an industry-wide standard for health records, there is also widespread recognition that information technology is insufficient to support such a system at this time. The most cited flaw in the HITECH mandate is that it does not facilitate patient care, rather the intense time investment needed to input patient data diminishes time for patient interactions. Furthermore, few physicians are able to exchange these records with other organizations, thereby neutralizing one of the primary purposes EHRs were introduced. The many flaws in the current EHR system have compelled the American Medical Association and other industry groups to push for new initiatives including: Design a user friendly EHR system with the assistance of the EHR vendor community Improve EHR system purchasing options for physicians Partner with the Office of the National Coordinator for Health Information Technology to address issues and implement policies with less draconian penalties Reduce the number of requirements for EHR vendor certification so that they may better respond to the input of the industry. Allow physicians and healthcare workers to use the services of clerical staff to fulfill certain administrative responsibilities related to EHR use Despite the immense dissatisfaction with the electronics health records policies of the government, it is almost a certainty that EHRs are here to stay. In the future, electronic health records will be integral to patient care, but, unfortunately, only in the aftermath of immense industry upheaval.
Written by: Robert Moghim, M.D., CEO- Moghim Medical Consulting Inc.