Electronic Health Records & Healthcare Information Technology in the United States, 2011 Westlake III April 14, 2011 William A. Bornstein, MD, PhD Chief Quality & Medical Officer Emory Healthcare Acronyms 2 EMR=Electronic Medical Record EHR=Electronic Health Record CPR=Computerized Patient Record (Older Term) HIT=Healthcare Information Technology 2
Topics 3 Why? The case for EHRs Risks and unintended consequences Evidence for the benefits of EHRs Current state of EHR adoption in the US Meaningful Use and the next several years in the US 3 Why EHRs? The Value Proposition 4 Access to complete patient information from multiple locations, by multiple users simultaneously Individual patient real time clinical decision support integrated into workflow (reminders and alerts) Practice (patient population) management (for example, registries) 4
Why EHRs? The Value Proposition 5 Quality data collection in the process of care For reporting For improvement Enhanced communication Among caregivers With patients 5 Definition of the CPR, 1992 6 A computer-based patient record (CPR) is an electronic patient record (i.e., a repository of health care information about a single patient) that resides in a system specifically designed to support users by providing accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids. IOM, 1992
Themes Missing from the 1992 IOM Definition of the CPR EHR as a communication tool Provider-patient Inter-provider Care coordination Data analysis and management across groups of patients Quality measurement by individuals and groups Registry functionality 7 7
10.1377/hlthaff.2011.0178 HEALTH AFFAIRS 30, NO. 3 (2011): 464 471 We found that 92 percent of the recent articles on health information technology reached conclusions that were positive overall. However, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving the potential of health information technology. 10.1377/hlthaff.2011.0178 HEALTH AFFAIRS 30, NO. 3 (2011): 464 471
By early 2008, 4% of physicians have fully functional EMRs 13% have basic EMRs 15 By 2008, 1.5% of US hospitals have comprehensive EMR 7.6% have basic EMR
Major Perceived Barriers to Adoption of Electronic Health Records (EHRs) among Hospitals with Electronic-Records Systems as Compared with Hospitals without Systems. Jha AK et al. N Engl J Med 2009;360:1628-1638. Perceived Facilitators of Adoption of Electronic-Records Systems among Hospitals with Systems as Compared with Hospitals without Systems. Jha AK et al. N Engl J Med 2009;360:1628-1638.
The Federal Response: Meaningful Use American Recovery and Reinvestment Act of 2009 (ARRA) February 2009 ( Stimulus Legislation) Health Information Technology for Economic and Clinical Health (HITECH) Act: $19.2 billion as incentives for meaningful adoption of EHRs Financial incentives 2011-2015 followed by Medicare payment penalties for non-adopters HITECH/Meaningful Use Goals Improve quality, safety, and efficiency of care; reduce disparities Engage patients and families in care Promote public and population health Improve care coordination Promote privacy and security of EHRs 20
Meaningful Use Stages Stage 1, 2011-2012: data capture and sharing Stage 2, 2013-2014: advanced clinical processes Stage 3, 2015+: improved outcomes 21 Summary and Conclusions EHR/Healthcare IT adoption in the US is still low and behind many developed and emerging countries HITECH/ Meaningful Use Incentives are aimed accelerating adoption Despite early reports of unintended consequences, most recent evidence points towards benefits of HIT 22
Summary and Conclusions Meaningful healthcare reform in the US will require a robust Healthcare IT infrastructure For risk adjustment For coordination of care For monitoring and improving quality The Triple Aim Improved health care Reduced cost Improved health (of the population) 23