By several different measures, the past President and current President of the United States have little in common. But both do share a vision of transitioning the American healthcare system to the use of electronic health records (EHRs) as quickly as possible – George W. Bush backed a 2014 deadline and Barack Obama has provisioned incentives within ARRA to drive adoption by 2015.
The byproduct of this type of commitment has spurred heavy investment in the healthcare IT industry, focused primarily on the development of EHR technology to improve operational efficiency and patient care. So, why are some physicians rejecting the notion of EHRs or in some cases … de-installing them? You would think with strong Presidential support and no shortage of financial investment in the industry that penetration of EHRs into the physician market would exceed 33 percent.
The reality is that at least 67 percent of physicians today who receive information from caregivers or labs outside of their care setting depend on paper. What they care about is having timely and reliable access to the information they need – not whether it comes to them in paper or electronic format – and they most certainly won’t stop depending on paper overnight. In fact, even physicians with EHRs often must depend on paper, especially if their EHR is not interfaced to the data sources. Without interfaces, their EHRs are empty and, by many accounts, not very useful. If the EHR isn’t useful, they say, why disrupt the familiar paper-based workflow? Enter ARRA and meaningful use. The general consensus is that health information exchanges are important and necessary to improve care coordination. The challenge is how to close the gap by the ARRA-mandated deadline when electronic delivery of 100 percent of summary-of-care records will be required. If you believe the published EHR adoption statistics, over the next six years 1 in every 3 physicians will be involved in an EHR upgrade, while 2 out of 3 will either be implementing one or protesting it all together. All of this – including the adoption and implementation of standards to enable HIE functionality – must be smoothed over in less than 6 years. Aggressive … but doable.
So, what do we do between now and then? We need to embrace the reality of health information exchange – and the centrality of paper to the way the system functions in the here and now – so that we can transition from the paper-based reality to the electronic ideal realistically. If we meet physician practices where they are in the technology adoption curve, we make HIE useful to them and help them realize the benefits of the transition. We need to enable health information exchange from paper-based to paper-based practices, paperless to paper-based, and paperless to paperless. Successful exchanges will offer a multitude of options for access to care summaries ranging from auto-print/fax, an electronic inbox, web-based community health records, to practice EHR integration. Make sure the least common denominator – paper – is always covered. It surely isn’t disappearing anytime soon.
