The EHR Shortage

Although EHR usage increased in 2012 from 22 percent of providers to 35%, that still leaves 65% of practicing physicians who are not yet using computerized records. The vast majority of these are in small, doctor owned practices. Large healthcare organizations, including hospitals and university medical systems that own medical outpatient practices often find it in their best interests to purchase a new system and influence or require their practices to implement an EHR. This decision is likely made as much for the Meaningful Use incentives as it is for the potential improvements in healthcare. Providers can earn up to $44,000 from Medicare incentives for continually hitting meaningful use targets over several years, and for larger groups, this can add up. In a small practice, one featuring at most a few providers, the practice itself needs to shoulder the costs to purchase and implement an EHR. These, combined with the potential for lost productivity as all the staff becomes acclimated to new roles, do not necessarily outweigh the incentives provided for Meaningful Use incentives. This might provide one reason why smaller practices are less likely to embrace EHR opportunities for their offices.

Of course, a practice willing to embrace the changes that come with an EHR, rather than trying to keep things the same will hopefully realize that the benefits are not limited to meaningful use incentive payments. There are more reasons why health policy experts have encouraged EHR usage. Some of these things include an increased focus on quality, reduced administrative costs and ideally, a patient centered system that improves the doctor-patient relationship and encourages patients to stay active with the practice. Several other industries, including banking and travel, allow their customers to access to their accounts at all times and encourage integration. There are some healthcare systems that have embraced this as well, though perhaps not enough.  This is a major centerpiece of EHR benefits. While efforts to increase quality and reduce costs could be handled with great difficulty without electronics, real patient engagement cannot. Patients are limited to calling their doctors or waiting anxiously for a call with results. With electronic records, they can access lab and test results, send quick messages, and view appointment schedules quickly and at any time that is acceptable to them. This instant access to their data is what should be encouraged.

So how can we move forward in increasing the prevalence of EHR usage? There are four major players in this game. The government has done its part, both in the creation of Meaningful Use incentives and efforts as part of the Affordable Care Act to promote HIT. This leaves three groups, HIT professionals, the healthcare delivery system, and the patients. The first two groups need to work together to develop a system that encourages providers to take advantage of the benefits of IT while making it easy to make the switch over without alienating the patient through increased costs or time. And the patients need to buy in, as a patient centric system with no actual patient engagement serves no one. At the same time, healthcare professionals also need to be willing to embrace this system, to actually be willing to attempt the changes necessary so that the benefits may be seen, even if it does take some time.

Further Reading:

Health Affairs: “HIT’s Unfulfilled Promise”

Information Week: “EHRs, Practice Consolidation Can Alleviate Doc Shortage”

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