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Wagons Ho! ...Or, Facing Up to the Core Conundrum Around EHRs Right Now

June 3, 2014
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The only way forward now on EHRs is ahead, into uncharted territory

As we reported here on June 2, the Premier healthcare alliance on that date released the results of a new survey that found both that “Nearly half (49 percent) of c-suite healthcare executives plan to make their largest capital investments over the next year in HIT, to include electronic health records (EHRs), advanced data analytics and telecommunications”; but also that “41 percent of respondents are dissatisfied or indifferent in regards to their current EHR standards.”

As Michael J. Alkire, Premier’s COO, said in a statement upon the release of the survey results, “Hospitals are making necessary investments in infrastructure to meet the demands of this new generation of healthcare. These investments are targeting HIT to provide more connected and efficient patient care, and modern clinical equipment that can deliver improved outcomes.” At the same time, Alkire noted, “What we are hearing increasingly from healthcare leaders is dissatisfaction with their existing EHR systems, often citing cost and difficulty of use. Providers need a solution that integrates clinical, financial and operational data across their hospitals and health systems; the majority of EHR systems cannot do that.”

In other words, we as an industry have reached an exquisitely challenging point in the evolution of the electronic health record. EHR implementation has become an absolute minimum set of tasks for every hospital and virtually every physician in the U.S., both because of the formal policy demands coming out of the HITECH (Health Information Technology for Economic and Clinical Health) Act and the Affordable Care Act (ACA); but even more so because of the obviousness of the need to optimize care delivery, efficiency, cost-effectiveness, and patient and community satisfaction through automation. Yet at the same time, as EHR adoption becomes universalized, the core shortfalls of all existing EHRs are also becoming more and more self-evident.

And those defects and deficits are inherent in all types of EHRs—whether commercially available or self-developed. The reality is that as nearly all physicians and other clinicians come to use EHRs as core tools in their work-lives, the weaknesses and gaps in all EHRs are becoming exposed.

And yet, because of the need to push ahead not only to fulfill the requirements of meaningful use, and to satisfy the demands of value-based purchasing and readmissions reduction under the ACA and VBP under private health insurance regimens, as well as simply the need to be able to compete within local and regional healthcare markets—we’re going through a time when it’s essential to complete the adoption of deficient EHRs, which means all EHRs.

Thus, the frustration.

But the good news here is that the leaders of the truly pioneering patient care organizations in the U.S. are pushing ahead to optimize EHRs and clinical information systems, and are already beginning to lead the way forward, almost as the Oregon Trail pioneers created the first trails west through the wilderness towards the Pacific territories, and showed others how to follow in their wake.

Thus, the inevitable phase of frustration, before the phase of maturation and optimization. So fundamentally, when it comes down to it, everyone in the healthcare industry will just have to keep pressing forward through this immature phase. There certainly is no option of going back; “back” would mean to a catastrophically inefficient and ineffective paper-based healthcare delivery system that was unsustainable even before the aging of the U.S. population and the surge in chronic illness put the U.S. healthcare system on a path towards cataclysm. The only way is forward, through the complex challenges of the next several years, and towards true optimization and the facilitation of the new healthcare—a healthcare system of improved care quality, patient safety, efficiency, cost-effectiveness, connectedness to patients, families, and communities, and true value. Like the pioneer trails of the old West, going back is not an option, whatever the current weariness of an entire industry.