The federal government, via the HITECH Act, and many an EHR vendor are hoping for broad adoption of EHRs in the goal to digitize the healthcare sector, which today is honestly, pretty abysmal. And why is EHR adoption so low? Pretty simple really, EHR vendors have not adequately demonstrated to the market that there is indeed value creation for the end user after adoption and go live. In fact, one could easily argue the exact opposite occurs when one looks at the productivity hit a practice typically takes (20-30%) in the first year. Practices get paid by throughput, how many patients are seen in a given day, so if an EHR hits a practice with a 25% productivity hit, where does one make that up, working extra hours, laying off an employee or two? Not exactly attractive options.
Yes, hospitals will adopt and meet meaningful use requirements as the future CMS penalties will simply be too painful to do otherwise. Private practices, however, may just forgo adoption and decide to not serve CMS (Medicare/Medicaid) patients. It remains to be seen what direction this will take but as I stated in a recent keynote at the PatientKeeper User Conference, the focus of EHRs and their successful deployment, adoption and use needs to be based on what is the value that is delivered to the end user, the physician/clinician. For too long and even today, all the grand talk of EHRs and adoption thereof focuses on the broader public good. Yes, there will be a broader public good but if we don’t get back to focusing on delivering true, meaningful value to the end user all this talk, incentives and promotion will fall on deaf ears and many a tax dollar will be wasted.
As an aside, we have stated before on this site, the consumer/citizen may play an important role in the future. As the first comment in response to this Boston Globe article this week puts it, he/she would not go to a doctor that did not have an EHR in place. This is something that the digital natives of this nation who are beginning to get married and settle down with families of their own will increasingly demand. EHR adoption will come, the question is how fast and what will be the forcing functions. Right now, just not convinced that HITECH Act $$$ will do it at the practice level.
And just by way of example regarding those youthful digital natives, my 25yr old son found both his doctor and dentist via the online user community Yelp. He’s quite happy with both.
John,
This seems to echo three of the six essays posted so far in Kuraitis and Kibbe’s series “Is HITECH working?”:
_____
1. Hospitals are grumbling but are playing in the game; success is not guaranteed.
2. Key physicians will sit on the sidelines (at least for now).
5. The stage is being set to enable patient-driven disruptive innovation.
_____
I understand the economics and the workflow challenges. As much as I advocate EMRs, I only advocate “good quality data, well managed,” and I speak often of how in Kaiser’s system-wide adoption, the system was only 1/3 of the cost, with the rest going to people issues.
I’m hardly an insider on the decision-making in DC (especially a year ago when it started) but I suspect slow adoption among small businesses isn’t a shock.
But I’m also pretty darn sure that providers who don’t adopt will increasingly be marginalized, as you suggest. I expect it’ll take quite a few years – perhaps a generation – before all the offline mom-and-pop operations retire. In the meantime I’m glad that progress will be accelerated by HITECH, which I expect it will.
For those who haven’t read it yet, I cannot overstate the importance (IMO) of reading that series. (Same for subscribing to this blog – a perpetual “must read.”)
John,
I would be interested in your comments on #Intuit’s pending acquisition of #Medfusion. See http://bit.ly/aAqva6 for details.
Cheers,
–rj