Prognosis on Electronic Medical Records: The Long Slog to Come

July 26, 2010

On July 13, 2010, HHS released final rules telling providers of care how to demonstrate the “meaningful use” of electronic medical records in order to be eligible for incentives starting in 2011. By 2015, most providers who don’t adopt electronic medical records will face penalties. The originally proposed rules were considered too rigid by many, and would have made it too difficult for hospitals and physicians to earn incentives. The final rules do give more flexibility than the initial rules published in January: the threshold to earn incentives is set somewhat lower and the bar is not an “all or nothing cliff.”

But even though the final rules are an improvement over the initial proposals, the provider community remains skeptical that the incentives – or penalties – in the rules are sufficient to entice a large number of providers to convert to electronic records. Most are predicting the dissemination will not be as fast or as deep as many would hope.

There is widespread support for the concept that electronic records can improve care. Global measures of the quality and safety of medical care show the potential impact of electronic records: countries with more extensive electronic records have better overall quality of care than the United States.

Yet, the data are also pretty clear about changing practice structure: it is hard and won’t happen overnight. Indeed, we already have data to say that the movement towards electronic records is going to be slow and somewhat painful.  A new study from the Center for Studying Health System Change (CHSC) tracks the use of e-prescribing and shows the scope of the problem.

Some consider e-prescribing an entry level component of a full electronic medical record; many groups and individuals have been promoting the use of e-prescribing systems for years. Indeed, vendors have all but given away these systems to encourage their use by physicians. But despite these efforts, the CHSC study shows that only two in five physicians in office-based ambulatory practice reported that IT was available in their practice to write prescriptions in 2008. And, I think, most critically, the authors reported that physicians who had access to e-prescribing did not necessarily use it routinely. Notably, about a quarter of those physicians reported using the technology “occasionally” or “not at all.” All told, in 2008, somewhat less than one third of ambulatory physician practices both had and used IT for prescription drugs.

The CHSC study was completed prior to the advent of federal financial incentives for the use of electronic records. It is almost certain that the numbers will improve as a result of the incentives and impending penalties. Even so, the CHSC findings are instructive about the challenges the implementation of full blown EMR strategies are likely to face.

The reality is: human behavior is difficult to change. And, though business schools have spent years developing change management structures for corporations, these methods are – at best – nascent in most physician practices in this country.

It is terrific that the federal government is providing technical assistance to practices to help them with IT implementation: that will certainly help with their success. But, we must be realistic about what can be accomplished and how long it will take. I do believe we will get there. But, this is truly a long distance race, not a sprint.