Barriers to EHR adoption
Current State of Adoption
In an annual utilization survey from Division of Health Care Statistics, CDC Hsiao et al. reports that about 50% of physicians in this country use some type of EMR (2010). The level of a basic EMR system that includes clinical documentation, medication and problems lists, computerized prescription ordering and viewing radiology images, the number drops to just under 25%. And the number of physicians using a fully functioning system is just 10% as of 2010.
Five years ago adoption among primary care physicians in other industrialized countries is significantly higher than the United States and Canada; Netherlands (98%), New Zealand (92%), the United Kingdom (89%) and Australia (79%). In the United States only 28% use EMRs, and only 23% in Canada (Schoen 2006).
In a white paper HIMSS lists barriers to adoption, three of which could be considered as technological - interoperability, data conversion and privacy/security issues (2009). Interoperability can be an issue with data sharing in health information exchanges (HIE), but also is often a problem within a hospital system or private practice as communication between legacy systems and ‘best of breed’ systems may not sharing the same transfer standards. This is a particular problem in light of the considerable number of different EHR vendors, and standards to connect information systems such as digital imaging and communications (DICOM), EHR laboratory interoperability and connectivity standard (ELINCS), various pharmaceutical, patient identifier and other communication standards.
Manual abstraction of patient data from paper charts can be a time consuming process. And though scanning is faster, it is not searchable. Consolidating legacy data into a reconciled enterprise patient index (EPI) involves health information management (HIM), a dedicated EPI team, database administrators, and department managers for any systems that contain patient data (AHIMA 2010).
Although the only privacy provision under meaningful use is to conduct or review a security risk analysis; and implement security measure and updates as necessary (Gantz 2011), this would be an additional cost of a practice initially implementing these security measures as required by HIPAA. Since all practices or healthcare entities with any legacy systems would have these security measures in place per HIPPA, this would not represent any additional burden.
Efficiency loss to the practitioner is a long-standing concern with EHR. Efficiency issues need to be addressed with a more intuitive application interface, workflow processes need to be standardized, simplified as much as possible, and then automated to improve efficiency (Breaux, 2007). The intrinsic value of these systems favors payers and patients over health care provider organizations, (Mitchell, 2008).
To address this fact, health plans in Massachusetts offered incentives such as free e-prescribing software to facilitate the deployment of electronic health records, a maneuver that resulted in Massachusetts having the highest use of e-prescribing nationally, with more than double the national average use of CPOE (Howell, 2009). The ARRA offers monetary incentives
Noncompliant providers will see a decrease in Medicare payments of one-percent per year starting in 2017 (Porter, 2009).
Resistance to Change
Adoption of EMRs requires a number of changes in practice patterns. Increased amount of time is required to use EMR than with traditional paper charts, changes of both clinical and office workflow require adjustment of practice, and for those providers uncomfortable with information technology, these changes can seem onerous. The problems can be particularly acute for smaller practices as there is less management leadership, experience with past process changes, and access to IT support staff (Miller 2004).
Information systems that are not fully integrated, requiring providers to switch between electronic systems, e.g. for documentation, and paper systems, for lab ordering, slows workflow and increasing the likely resistance to new systems.
- Hsiao C, Hing E, Socey TC, Cai B (2010). NCHS Health E-Stat, Division of Health Care Statistics, CDC. http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm
- HIMSS (2009) EMR White paper
- AHIMA (2010). Reconciling and Managing EMPIs.
- Breaux, T. (2007). Why Implement an Electronic Medical Record? MediaHealth Leaders. Link available at http://www.healthleadersmedia.com/content/hom-91292/why-implement-an-electronic-medical-record.html .
- Gantz S (2011). Jonline: Privacy and Security Considerations for EHR Incentives and Meaningful Use. ISACA Journal.
- Mitchell R. (2008). E-Medical Records: What Seems to be the Problem? Computerworld. Link available at http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=320828&pageNumber=1.
- Porter, S. (2009). Report Says Federal Government's Stimulus Funding Won't Cover EHR Costs. American Academy of Family Physicians. Link available at http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20090513pricewater-rpt.html
- Howell J (2009). Massachusetts Studies Reveal Importance of Incentives in Healthcare Technology Adoption.
- Miller RH, Sim I (2004). Physicians’ Use Of Electronic Medical Records: Barriers And Solutions. Health Affairs, 23(2): 116-126
Submitted by: Tim Peterson PA-C