As a Louisiana resident and a health care professional who witnessed the damage Hurricanes Katrina and Rita did to our state’s health care system, I was among the first crowd of cheerleaders for EHR adoption. There is nothing like a front row seat to the confusion and havoc of attempting to provide care to thousands of people whose medical records are underwater and lost forever to turn you into a devout advocate for EHRs, believe me.
Yet I will also be among the first to join the crowds clamoring for interoperability standards. Personally, I tend to like the comment of ONC’s Deputy National Coordinator for Programs and Policy Judy Murphy, RN, who compared EHRs to telephones.
“If you buy a telephone, it’s only as good as the other people who have telephones and can call,” Murphy said.
And she is correct. Look at like this: Patient Jane sees a primary care physician and a cardiologist. Both the PCP and the cardiologist have EHR systems, yet those systems cannot communicate with each other. Both providers are thus forced to fall back on telephone, email, fax and - unfortunately for Patient Jane – their patients to transport their own health information between their two offices. So has either of these providers been able to truly realize the value of EHRs?
No. And although there are hundreds, if not thousands, of surveys, studies and reports that tout the benefits of EHR implementation - including an improved ability to respond to patient issues; more effective management of patient treatment plans; and improved documentation, collections, patient service and clinical operations – these benefits mean little if the systems that deliver them cannot simultaneously deliver global communication with other systems.
Of course, hindsight is 20-20, as we all well know, and when the EHR movement was adopted at the federal level, I don’t think anyone realized how quickly and exponentially the EHR market would grow, which is why no interoperability standards were mandated at that point.
Now, however, the EHR market in North America alone is expected to reach $10.1 billion by the end of next year, and the pressure is on at the federal level to develop and implement those standards sooner rather than later.
But beyond interoperability, physicians must also occasionally deal with vendors that convince them they must purchase expensive EHR systems that are well beyond the actual needs of their practices. This leaves unsuspecting physicians encumbered with systems they cannot use, do not need and can’t afford. And in many of these cases, when the physician seeks help from the vendor in correcting an issue, understanding the functionality or evaluating an upgrade, the vendor has disappeared into the wind.
Yet I do believe relief is in sight. Interoperability standards are being developed that will eliminate much of the fly-by-night vendor issues, and an increasing number of providers are turning to Regional Extension Centers (RECs) for vendor-neutral assistance in determining precisely what type of system is needed to meet specific practice needs.
It is important, too, to understand that much in the same way that health care has evolved, so have EHRs.
EHRs: The Evolution
EHRs started in the U.S. in the late ‘60s. By 1980, Lockheed had developed the system that became known as Eclipsys, which featured Computerized Physician Order Entry (CPOE); Massachusetts General Hospital researchers had launched the Computer Stored Ambulatory Record project; and the Veterans Administration had begun development of the Decentralized Hospital Computer Program, a precursor to the Veterans Health Information Systems and Technology Architecture.
Over the years, EHRs have grown and expanded in response to the growth and expansion of our technological capabilities. Borrowing from Judy Murphy’s analogy, I’d compare it to the telephone. The tall, candlestick telephone created by Alexander Graham Bell in 1876 gave birth to the rotary phone in the 1930s, which was replaced by push-button phones in the 1960s. Those, in turn, were blown out of the water by the cordless phones of the 1980s, which were replaced by cell phones in the 1990s. These days, few people have landlines anymore, and almost everyone uses their cell phone for everything from phone calls and video conferencing to photography and online networking.
Likewise, the EHRs of old are evolving to meet the changing technology and – more importantly – the changing needs of users. The cutting edge, top-of-the-line EHR of today will be obsolete just a few years from now, not only because the technology itself will improve, but because health care providers will need a broader range of data to deliver the highest quality of care.
At the End of the Day
Bear it in mind, EHRs are here to stay, and that fact will not change. The sands of the hourglass are running out for health care providers who have been reluctant to make the transition from paper.
Why, you ask?
Because EHRs are a critical component in our nation’s efforts to improve health care quality. The overall vision is clear: a health care system in which providers and hospitals, regardless of geographic location, can instantly access a patient’s critical health information via an interoperable, secure, electronic network and provide seamless, coordinated, patient-centered care.
This vision includes a nationwide shift from a fee-for-service payment model to one based on value, quality and outcomes. It includes the incorporation of evidence-based practices, health care analytics and medical technology. And this vision – this health care nirvana, if you will – is not attainable without wide-scale adoption of its most basic, core element: EHRs.
Those providers who don’t get on board the EHR train now may soon find themselves stranded at the station while the rest of the health care system moves on to its next destination.