Obama has pushed EHR implementation as one of many solutions to the skyrocketing costs of healthcare, saying earlier this year that he is committed to “the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized.” Even so, the EHR upgrade remains only a grand outline, one missing the details that will determine the future. There is time, of course. The first funding through the stimulus bill won’t be available until next summer.
Dr. Blumenthal’s office is crafting an interoperability plan in combination with a pair of still-forming advisory boards: a health information policy committee and a health standards committee. The stimulus bill also promises increased federal reimbursement payments for hospitals with meaningful use of certified EHR. First, the government has to define what is meaningful and, as Dr. Stanley points out, the definition will have different meanings to different sectors of the $2.2 trillion-per-year healthcare industry.
Once those definitions are set, there is a timetable for additional reimbursement and a one-time bonus of $2 million for institutions that implement “meaningful use.” There also will be escalating Medicare penalties for institutions that fail to show the kind of technological progress federal officials are looking for.
But even if those standards are set, it doesn’t guarantee hospitals will buy the technology that vendors are selling. Many in the HM field argue that the next step is the most important one.
“Physician adoption of electronic health records is the central, critical issue this industry is facing over the next few years,” says Todd Johnson, president of Salar Inc., a Baltimore-based firm that develops software applications for clinical documentation. “There are a lot of really bright people working on criteria that make electronic health records good tools. However, there doesn’t seem to be an organized body focused on the EHR adoption issues. Anybody can buy all these tools, but if you ultimately can’t get the right people to use them at the right time, the investment doesn’t yield much, right?”
Johnson, who thinks the federal focus on EHR technology is a main driver behind his firm’s 25% sales growth spurt in the first six months of 2009, says physicians have to be a driving force in the EMR implementation process or the system will fail. Take the industry’s classic cautionary tale: Cedars-Sinai Medical Center in Los Angeles. The oft-innovative institution made national headlines in 2002 when it scrapped a three-month-old, $34 million computerized physician order entry (CPOE) system after more than 400 doctors demanded it be shelved.
“The right thing to do is really steer the discussion to physician adoption,” Johnson says. “Make sure that physicians have a choice. Every hospital—and rightly so—wants to see the benefit of their investment in electronic medical records. If physicians don’t have a voice in what will or won’t work, purchasing decisions will be made without them. And that’s not a great thing. Hospital leadership needs to be cognizant of that.”
Dr. Stanley thinks hospitalists should take a proactive approach to EHR implementation at their hospitals. Many potential issues could be solved if hospitalists take an active role earlier in the process.
“As tedious as those early meetings are,” Dr. Stanley says, “that’s where the big planning and decisions get made. The problem is most people think of it as tedious and boring because they don’t appreciate the technology.”