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EHR Adoption Lags Despite Success Stories

A recent Center for Information Technology Leadership (CITL) study comparing health information technology (IT) in the Department of Veteran Affairs (VA) to norms in the private sector concludes that the VA spent proportionately more on IT than the private health care sector spent between 1997 and 2007, but it achieved higher levels of IT adoption and quality of care.

According to the study, entitled The Value From Investments in Health Information Technology at the U.S. Department of Veterans Affairs, “The potential value of the VA’s health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs.”
“This study,” the authors write, “serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.”
Some say, however, that the study is based on conjecture and immaterial.
“Naturally, there remains a core logic to the contention that HIT is going to help the healthcare sector save money,” writes Healthcare IT News editor Jeff Rowe. “But policymakers need to develop more concrete and realistic projections of those savings in order to maintain public support for the significant amount of taxpayer dollars that are currently being spent on encouraging the sector’s IT transition.”
Even the authors of the CITL study, published in the current issue of Health Affairs, admit the VA outcome is uncommon.
“In contrast [to the VA success story], adoption of electronic health records and other health IT applications has remained persistently low in private-sector hospitals and provider practices across the United States,” the authors of the study note.

Obstacles Persist

The article Accelerating the Use of Electronic Health Records in Physician Practices, published Jan. 21 in The New England Journal of Medicine (NEJM), concludes that even with large hospital systems offering incentives above and beyond that being offered by the government for meaningful use of certified electronic health records (EHR) “obstacles persist.”
“EHR products remain expensive to install and maintain—cost issues that should not be underestimated,” the authors write.
And then there’s the security issue. “The capability of providing a secure electronic environment for patient data—like the capability of providing reliable data storage—is beyond the reach of most individual physician practices,” the authors affirm. “Truly secure and reliable EHRs are currently feasible only for larger organizations with centrally supported technological capabilities.”

Supporting Evidence

To overcome these hurdles and promote EHR adoption, North Shore Hospital System recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its EHR. Additionally, the Long Island, N.Y. hospital will reportedly pay 50 percent of the installation costs to physicians who install an EHR that communicates with the hospital or 85 percent of the installation costs to physicians who also share de-identified data on the quality of care.
Note: Support for adopting information technology systems is exempt from the Stark law, which prohibits hospitals from offering physicians incentives for promoting referrals on admission.
In addition to private funding (such as North Shore’s) and federal incentive payments (as provided in the stimulus bill), other factors encourage private practices to adopt EHR.
According to the NEJM article, “The prices of EHRs have come down as the volume of software licenses being sold has increased.” As systems improve, time-consuming data entry concerns are also being relieved, the authors say. Other factors promoting EHR adoption include: system usability improvements; EHR capability improvements; and an increased emphasis on quality of care in EHR system software.

Speculation Abounds

The authors speculate that once widespread EHR adoption by physicians is achieved other technology will be advanced, such as cell phone technology for messaging, the capability of moving data from home monitory devices to cell phones and upstream to EHRs, yet-to-be-developed software capabilities that will allow data streams within clinical workflows, and the effective provision of out-of-office care.

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