Electronic Health Records: Are We There Yet? What’s Taking So Long?

Jun 4, 2013, 4:48 PM, Posted by

A doctor seeking information on a computer, two nurses are in the background.

I am a family physician, but one who doesn’t currently practice and importantly, one who isn’t slogging day after day through health care transformation. I do not want to be presumptuous here because the doctors and other health professionals who are doing this hard work are the heroes. They are caring for patients while at the same time facing tremendous pressure to transform their life’s work.  That includes overwhelming pressure to adopt and use new information technology.

This level of change is hard, difficult and confusing—with both forward progress and slips backward. Nevertheless, doctors, take heart, because you are making progress. It may be slow at times, but it’s substantial—and it’s impressive. Thank you. 

The Annals of Internal Medicine today published a study (I was one of the authors) finding that more than 40 percent of U.S. physicians have adopted at least a basic electronic health record (EHR),  highlighting continued progress in the rate of national physician adoption of EHRs. The study, also found that a much smaller number, about 9.8 percent of physicians, are ready for meaningful use of this new technology. 

Some might say, “Wake up, folks!”   Look at those small meaningful use numbers.  Change course, now.  After all of this time and tax-payer expense, less than 10 percent of doctors are actually ready to use these important tools meaningfully. What’s up with that? 

To me, though, this study is good news. All who care about health care transformation should be heartened by the progress—but also impressed by the enormous challenge that our health professionals have undertaken.

This study was also authored by Catherine DesRoches of Mathematica Policy Research, Karen Donelan of the Mongan Institute for Health Policy at Massachusetts General Hospital, and Anne-Marie Audet of the Commonwealth Fund. Both RWJF and the Commonwealth Fund (CMWF) supported the study. Staff from the Office of the National Coordinator for Health Information Technology (ONC) reviewed and commented on the survey instrument.

RWJF has a long-standing commitment and interest in helping the nation understand where we are with the implementation of this important technology. We also have a long-standing collaboration with ONC in monitoring the rate of EHR adoption. RWJF has produced an annual report on the state of that adoption since 2006 and will release the next edition in a few weeks. We also value collaboration with other funders, as we’ve done here with CMWF.

Automation of clinical information in health care is vitally important for overall health care transformation. But—and this point is critical—it is obviously not sufficient. The issue here is not and never has been “just add a dollop of HIT” and presto—stand back and behold the transformation.   Adopting HIT is just one of many steps, albeit a significant one. Actually transforming physician practice using HIT and many other tools is significantly harder and more complex. 

In this study we see ongoing increases in the rate of adoption of the basic EHR as well as the relatively small numbers of doctors ready to use the technology meaningfully. But nobody should be surprised at what only appear to be low rates of meaningful use. I believe we’re on a series of “change curves”—one for adopting the technology and another for actually using it. We’re at the early stage, maybe even a relatively flat part of that use curve. It is, however, interesting that this study also shows that about 40 percent of doctors are close—very close—to meeting meaningful use criteria.  That means the total for both currently meeting and nearly meeting meaningful use is actually about 50 percent. That number starts to be impressive.  We’d also expect to see even more doctors meeting criteria, and more getting close, in coming months and years.

What about the pending increasing rigor of meaningful use standards? That increasing rigor could seem very tough.  The “directive” parts of these rules can indeed send some wrong and irritating signals, but the toughness of the rule is not really the point.  Doctors want to provide great care for their patients, and they desperately need tools to help them do that. Once the other pieces of care transformation support their magnificent professional work ethic I know that American doctors will blow right by what might have seemed like tough standards and instead push hard for more and more capabilities in their relentless drive to provide masterful care. 

It would be helpful if those developing the technology could be as empathetic as possible to the needs of doctors and others using use the technology—like, say, Apple developing and refining new products.  Also, health professionals should be extremely vocal, not against adopting and using the new technology, but about demanding that the technology be as useful as possible to them as they create awesome care experiences for their patients.

There is obviously no going back. We must transform care—to make it a gleaming American triumph.  We cannot do that gargantuan task without using health information technology.  While I suppose the nation could have taken a heavy handed, centralized approach, forcing one-size fits all technology on our doctors, nobody wanted or wants that.  It would have been the wrong path, and a disastrous one at that. Instead, we’re adopting, learning, creating and innovating—and making progress. 

So, take heart, heroes. The journey is long—but we’re right about where we should be.