April 23, 2012
With billions of dollars of HITECH Act incentives are being waved in front of healthcare providers for the meaningful use of health IT, you shouldn't be surprised to learn that the percentage of healthcare providers using digital records has doubled over the last two years. Undoubtedly, that's impressive progress, considering that e-health record technology has been around for decades, and adoption was in single-digit percentages until very recently. But digging below the surface, there are a couple key things to keep in perspective.
For starters, it's a good thing the HITECH Act's financial incentives are tied to a laundry list of objectives and measures that healthcare providers need to accomplish through the meaningful use of health IT, and aren't just being paid for the broad adoption of EHRs. As you probably know, the HITECH Act Meaningful Use incentive program has three stages, and with each stage there's a more complex set of objectives for healthcare providers to achieve to receive payments. Without those MU benchmarks, there's no telling how EHRs would be used--or not used--once they're out of the box. As it is, even with EHR adoption growing--and the MU program is probably driving the majority of those implementations--clinicians are still glued to paper. Doug Fridsma, director of the Office of Standards and Interoperability of the Office of the National Coordinator, stated at an American Health Information Management Association conference this week that the number of primary care physicians using EHRs has doubled to 40% from 20% in two years, and since 2009, the number of hospitals adopting the technology has more than doubled to 35% from 16%. But despite that progress, another recent sobering study shows that 8-in-10 healthcare organizations--from doctor offices to hospitals--still use some form of paper records. Digital pen maker Anoto found in a recent survey of professionals at 103 healthcare organizations of various sizes that while three-quarters have rolled out EHRs, 80% of them still use paper based records in some fashion. Anyone that's been involved with an EHR rollout knows that getting medical and administrative staff to use health IT tools is among the biggest hurdles, and that bad habits can persist. The Meaningful Use programs attempt to get healthcare providers to embrace better habits by requiring them to electronically document key data about patients, such as whether they smoke, as well as conduct key safety measures, like ordering drugs electronically and automatically checking for possible drug interactions. Without being encouraged by HITECH incentives to use the various features of EHRs, surely many clinicians would choose to ignore those capabilities indefinitely. That leads me to another key point: Without doctors using EHRs, you're not going to get buy-in from patients to use personal health records to manage their own health. When patients are relatively healthy, encounters with healthcare providers are few and far between. Starting a PHR to track very occasional vaccinations or even to record a yearly exam isn't a high priority for a lot of people unless it's super easy to do. That means having data available from healthcare provider to load into a digital record, not typed by hand by the patient. And it also means giving patients a reason to visit a PHR more than once a year, if that. Chronically ill patients certainly have good reason to use PHRs to manage prescriptions, medical appointments, and lab results, and to refer to discharge instructions after a hospitalization. But again, if PHRs are too hard to use--and if there's no data that's available to be loaded into them--few patients will use them. "Widespread consumer adoption of PHRs remains elusive," said Lynne Dunbrack, program director at IDC Health Insights. "Uptake and reasons expressed for not using a PHR have remained remarkably consistent for the past five years," she said in an email interview with InformationWeek Healthcare. According to an IDC Health Insights' Connected Health Consumer Survey conducted in 2011, only 7% of respondents reported ever having used a PHR, and less than half of these respondents (47.6%) are still using one to manage their family's health, she said. When asked why they did not use a PHR, about 51% of respondents indicated that they were not exposed to the concept of a PHR. In 2006, when a similar IDC Health Insights survey was conducted, approximately 7% of respondents indicated that they used a PC-based or Web-based PHR, and a little more than half (51.9%) were unaware of PHRs. But as more doctors use EHRs, its likely more patients will use PHRs. "If you take into consideration patient portals, which provide a patient view into their electronic health records and are a form of tethered PHRs, consumer use will begin to increase modestly as physicians attempt to encourage their patients to use the patient portal to meet the Stage 2 meaningful use measurement objectives," said Dunbrack. "Qualifying for Meaningful Use incentives is dependent on patients taking action," she said. Under MU requirements, not only do providers have to provide more than half of their patients online access to their health information and the ability to download it and share with third parties, but more than 10% of patients have to actually do so. In addition, more than 10% of unique patients seen by an eligible provider during the EHR MU reporting period will have to send a secure message. "To achieve this measure, providers will have to promote the availability of their patient portals or PHRs and secure messaging with their practice," she said. Stage 2 requirements take effect in October 2013 for eligible hospitals and in January 2014 for eligible providers. So while the HITECH Act's MU program is certainly fueling adoption of EHRs by physicians, the legislation will also eventually prompt more patients to use PHRs to manage their health information as well. But for health IT to have a long term impact on productivity, patient safety, and process efficiency, "meaningful use" will need to continue long after the Meaningful Use incentives programs end. The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)
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