EHR: Working Towards Improvement

The year 2012 was the largest so far in terms of EHR use and implementation. At the end of December, the Centers for Medicare and Medicaid Services paid out an estimated 1.2 billion dollars to hospitals and providers for EHR related incentive payments. And more groups are getting into the game. At the beginning of 2013, on the first eligible day to file, an additional 2,000 eligible professionals filed claims. It is clear that EHR usage is growing and will continue to do so as we move forward through the various stages of HITECH.

However, just adopting an EHR is not sufficient. The idea behind promoting EHR is to take advantage of several areas in which healthcare can be improved. These areas include reducing repetitive tests, improved quality through decreased adverse drug effects, improved preventive care, and greater patient compliance. But is all of this money being paid out to hospitals actually serving to improve healthcare? Or are providers and hospitals doing the bare minimum to qualify for payments and making little to no effort to ascertain whether it does anything? Early on, there were more indications that the money wasn’t doing as it was intended. A NY Times article in September indicated that providers were taking advantage of the ease of ordering and not checking for repeats. Although this data was drawn from before Meaningful Use guidelines were finalized, there are, as there should be, some concerns over whether this program is effectively designed, implemented and executed.

In the area of improved quality, the idea is that items such as drug interaction checking, a comprehensive list of medications and allergies will help avoid some of the major quality lapses that lead to higher costs and unnecessary medical treatment. Studies exploring a link have been sparse. A recent study, however, has found a link between quality and EHR usage. In 2013, Health Affairs published the results of an investigation involving primary care practices in New York City. The Primary Care Information Project provided subsidized EHRs for practices in underserved NYC neighborhoods. It found that mere participation in the project was not enough to show quality improvement, but practices with extensive technical support, and perhaps more importantly, time to learn, were able to achieve their goals.

What we see is that EHR use is still a work in progress. Systems on their own are not capable of bringing about the improvements required to improve healthcare. What is needed are providers who are dedicated to changing the way they practice and enough support to help them focus on these changes in order to ensure that they happen.

Further Reading:

Modern Healthcare: Whopping $1.2 billion in EHR payments in December: http://bit.ly/VHbFjy

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records: http://content.healthaffairs.org/content/32/1/53.abstract

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