In the future, electronic health records (EHRs) will integrate family histories, comprehensive genomic data, and real-time biometric data, with the growing trove of health information already being captured. The expectation is that these advances will lead to improved and more personalized diagnoses, treatments, and prevention plans. Of course, we’re not quite there yet. However, forces have begun to align to make the latest EHRs more useful and ready for adoption.
EHRs are poised to become the norm for every hospital, outpatient clinic, medical group, and private practitioner. And I believe that is a very good thing.
Here’s why you should get on board now:
- Paper records are inefficient – Just like older card filing systems in libraries, paper records are, well, inefficient. They can’t be in two places at once, they can be misplaced, handwritten notes may be illegible, they take up physical space, they aren’t integrated with claims and billing, and the information within them isn’t easily shared. Those using EHRs will have an initial learning curve, but ultimately they will improve administrative efficiency, making medical record-keeping faster, better, and easier.
- EHRs are good for patients – EHRs improve a patient’s access to useful information. While patients can’t directly access an EHR, most EHRs will enable patient access to certain medical information through a patient health record (PHR). The typical PHR gives patients an easy, secure way to access appointments, prescriptions, test results, immunizations, preventative services, and secure messaging, which facilitates much better communication between a patient and their doctor.
- EHR solutions are good now, and they will continue to get better – The usability, technology, and capabilities of EHRs has improved greatly. They are designed to work with more specialties than ever. They are becoming easier to use, less costly to implement and maintain, and more connected to an entire ecosystem of useful tools and features. In particular, cloud-based systems, such as that offered by Practice Fusion, will allow small groups or private practices to get up and running quickly, without upfront investments in technical infrastructure or specialized IT knowledge (check here for a complete list of certified EHR products).
- Better Access to Data – The ability to aggregate medical data for certain patient populations should help physicians monitor how well their patient’s are controlling conditions such as diabetes, heart disease, and hypertension. They’ll also keep track of immunizations and preventative care needs. However, the biggest impact of this data may not be to an individual doctor’s patient panel. Anonymized (de-identified) data extracted from EHRs may ultimately be used for improve predictive modeling, comparative research (comparing drugs, treatments or medical devices), real-time surveillance (to track the spread of TB and other infectious diseases), and adverse event monitoring.
- Government incentives – The HITECH Act of 2009 provides incentives of up to $44,000 over 5 years to eligible professionals who adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. But you should start now. The maximum incentive is only available for those who demonstrate “meaningful use” by 2012 (Also see the Medicare Electronic Health Record Incentive Program for Eligible Professionals PDF for a good summary). To receive the latest updates on these incentive programs, subscribe to the CMS EHR Incentive Programs Listserv.
- Healthcare Information Exchanges – The holy grail of health care data interoperability is the healthcare information exchange (HIE). HIE’s allow the sharing of healthcare information electronically across organizations: within a hospital system, community, or region. By linking patient data with multiple providers, HIEs improve the continuity of care. Secondly, the exchanges reduce the expenses and time that would otherwise be spent for duplicate tests, locating missing patient information, printing and copying documents, scanning and faxing documents, mailing patient charts, and the manual communications needed to verify the delivery and receipt of information, referrals, and test results.
- Good Data Security and Privacy Compliance – Data security and privacy compliance may be the most important things for health information systems to get right. The good news is that the tools you need for excellent data security and compliance with privacy rules are readily available. In fact, any worthy EHR solution will embrace these features: secure data warehouses, backup systems, redundant power supplies, data encryption, and a Certificate of Compliance by an Authorized Testing and Certification Body for each EHR module. There are even more novel solutions to address the complex flow of data in HIEs. For example, trust networks, like those designed by Resilient Network Systems, allow owners to apply customized privacy policies to control access and use of their data.
There is a vast graveyard of well-documented failures that have left many skeptical about the benefits of EHRs.
EHRs and EMRs have been around for over 30 years and I’ve seen first-hand how much money has been wasted on HIT systems. Why do they fail? There are plenty of good reasons EHRs or other ehealth initiatives may fail. Here are just a few:
- EHRs are not a substitute for good medicine
- You did not fix broken processes or redesign workflow before implementation
- You expected to solve a problem the EHR was not designed to solve
- Your EHR was poorly designed
- Your EHR was poorly implemented
- Your training was inadequate
- You did not get buy-in/commitment from staff
- You selected the wrong solution for your practice
Still, I was struck, though not surprised, when I saw the recent electronic health records study published in the Archives of Internal Medicine on January 24, 2011, concluding that there is no consistent association between quality indicators and the use of EHRs. The study, entitled Electronic Health Records and Clinical Decision Support Systems, Impact on National Ambulatory Care Quality focused on the use of electronic health records (EHRs) and Clinical decision support used in the ambulatory setting between 2005 and 2007.
To be clear, it wasn’t so much the results or conclusion of this study that struck me. You see, PLoS Medicine recently published a meta-analysis examining 53 systematic reviews that assessed the impact of various ehealth interventions. In his review, The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview, Sheikh and his colleagues reached a similar conclusion. According to the authors, “many of the clinical claims made about the most commonly deployed [digital health] technologies cannot be substantiated by the empirical evidence.”
What struck me was the futility of anyone who might use these articles in their attempts to argue against, or delay the implementation of EHRs.
Deep down, even the most stubborn physicians know there is no stopping the accelerating pace of EHR adoption. Resisting this change will not stop it from coming. That would be like continuing to use the typewriter in hopes of slowing down the spread of personal computers. It’s already happening and nothing you do now is going to stop it.
No one denies that technological innovations can improve health care, and no one can stop the move away from paper-based patient record systems.
Are EHRs perfect now? No. But their designs, features, and usability have gotten pretty damn good, especially in the last few years. As I’ve described above, there are compelling reasons for more medical practices to adopt EHRs now. With wider acceptance there will be more data and more innovation, which will ultimately lead to the promised improvements in clinical quality and health outcomes we are expecting.