It appears we are on the road to the “meaningful use” of healthcare IT. The Health Information Technology for Economic and Clinical Health Act (HITECH) is aimed at bringing U.S. healthcare into the information age. Many people who have never used an EHR can’t understand why we aren’t already using IT technology like banks and travel organizations already do. Funny but I observed that when the airlines switched to e-tickets, we now bring more paper to the airport to get through security than we did when we used old-fashioned paper airline tickets. With only 6 percent of the physicians and 2 percent of the hospitals (government statistics) using a complete EHR, there seems to be a lot of room for increased use. The paperless medical office and hospital sounds great but there needs to be a little reality facilitation in my opinion.
Why the low level of market adoption? Are those stubborn Luddite doctors the problem? There are some physicians who seem to always resist new technology and there are some who just love technology and can’t get enough. Then there are others who look at the new financial incentives in HITECH and just want to know “what do I need to do to get the government money in the program?” They want to check the box and don’t have a clue what meaningful use really is. Many clinicians who have tried to make EHRs work in their practice realize that most of the time the performance of present day EHRs are as exciting as an eight-track tape player. The EMR options available today have taken a hundred-plus-year-old documentation process, computerized it and amplified all of the dysfunction into “the solution.”
The April 2010 Health Affairs Journal has one report on how the EHR falls short in support of the new practice model. This is the future healthcare model that many thought leaders believe is necessary to truly reform healthcare. The innovative practice model includes: “extensive use of nonphysician health coaches, a higher staff-to-patient ratio, daily interdisciplinary meetings, close tracking of chronic disease markers to guide therapy, population health management using IT to target interventions, integrated pharmacy, mental health, social work and nutrition services and frequent evaluation of work flows.” The challenges found in applying the EHR to this new model of care were “sluggish and unreliable software, e-prescribing problems, problems with communication of lab results, clinical alerts and warnings, an excessive burden on physicians, inaccurate medication lists and an overall stifling of innovation.” The authors of the paper encourage “providers and policy makers to consider alternative software and informatics models before investing in currently available systems.” Investing in new informatics innovations would be a better use of taxpayer money than the present proposed model of government paying for products that the market has not found acceptable. The meaningful use requirements seem a bit incestuous to me. Advisors to the government that are establishing the criteria for meaningful use have a vested interest in maintaining the status quo. Products that claim to provide high value and that have been available for many years should not have a 6 percent adoption rate.
I struggle to think of other professional communities that have the same pressure to use electronic records. There is no Congressional electronic record, legal electronic record, executive electronic record because nobody has been able to figure out the secret sauce. These professionals still use paper because it works.
Humans have been communicating by writing on physical objects from cave walls to paper for hundreds of years. It is a communication standard that is tough to match. The EHRs of today are not there yet. Maybe you can understand why physicians and nurses are not that excited about computerized patient records/electronic health records. The EHR will be adopted when the value is obvious to all. It will be embraced when it is easy to use and does not disrupt the clinical work flow.
Maybe some of the innovations to make the computer user interface seem more like using paper, watching TV and listening to music will make the use of EHRs more compelling for clinicians. Isn’t it interesting that books on the computer seek to mimic the paper experience (turning pages and taking books off the shelf as in iBooks). Clinicians seem to be the largest professional group embracing the iPad . It is a very tactile product … kind of like paper. The tangibility of “touching the information” can’t be underestimated. Stay tuned, your EHR might soon be on iTunes.
Dr. Robert Corona is Vice President of Clinical, Medical and Scientific Affairs and Chief Medical Officer at Welch Allyn Inc. He serves as Chief Medical and Science Officer for Blue Highway; a Welch Allyn Company focused on innovation and advanced technology. Dr. Corona is a board-certified and practicing neuropathologist. He is board certified in anatomic pathology and medical management.