The advance of the electronic medical record (EMR) concept remains the longest-running "what's new" story in the history of healthcare. From its origins back in the 1970s among the first U.S. hospitals to self-develop EMRs, to the rise of more powerful commercial systems in the 1980s and early 1990s, to the realization that EMRs will be a crucial cog in the future of healthcare, the EMR saga continues to gain steam.
It's clear that the EMR will be the key IT facilitator for a host of healthcare system priorities: improvements in patient safety, care quality, and efficiency; the pay-for-performance movement; facilitation of physician care capability anywhere; and the development of regional health information organizations (RHIOs), and ultimately, of a national health information network (NHIN).
Not surprisingly, EMR implementation is now accelerating. Indeed, the 17th annual HIMSS Leadership Survey issued last year found that 87 percent of those it queried either already had EMRs or were planning to implement them soon.
A trio of trends
Three related trends are also emerging around the EMR as facilitator of industry change: the certification of EMR products; the acceleration of EMR implementation across the physician environment; and an emerging focus around the idea of patient self-management. Federal regulatory changes around hospital-physician collaboration are also playing a role.
With regard to certification, the recently created Certification Commission for Healthcare Information Technology (CCHIT, Chicago) for the first time in 2006 certified a slate of 33 commercially available EMR products as meeting "basic criteria for functionality, interoperability and security."
At the same time, EMR adoption has been accelerating in the physician world, and versions of the EMR have begun to move towards merging with the personal health record (PHR) concept, as the RHIO and NHIN concepts have emerged, all pointing to a broad future horizon for EMR usefulness.
With regard to physician organization adoption, David Kibbe, M.D., says, "The tipping point has already been passed for use of electronic health records." The Chapel Hill, N.C.-based Kibbe, who is senior advisor in the American Academy of Family Physicians Center for HIT, notes, "Physicians have been just as frustrated dealing with paper as the rest of us. I can now access my patient's health information from anywhere; that seems obvious, but it's huge."
Equally importantly, he says, connectivity with laboratories, pharmacies, and hospitals, and soon with patients directly, is the next frontier for EMRs.
Still, the reality is that implementation will require a long path, especially for physician groups.
Craig Lanway, CIO of the San Ramon, Calif.-based Hill Physicians Group, a 2,600-doctor independent practice association in Northern California, notes that though his group signed a contract for EMR implementation in late 2004, only 15 practices, representing 42 physicians, have so far gone fully live.
Though there is very broad support for EMR go-live among the IPA's independent physicians, "The EMR is a huge transformation for a practice; it disrupts everything in a practice," Lanway notes. Thus, it will be at least a few more years before most Hill doctors are fully electronic. By extension, he says, it's clear that EMR implementation across most doctors' practices will take longer than many would hope.
One development that should accelerate hospital-physician EMR collaboration is the August announcement by the Department of Health and Human Services of exceptions to the federal Stark/Anti-kickback laws. Those exceptions should enable many hospitals and health systems to move forward in helping physicians go live.
Meanwhile, providers are coming to see new areas of focus around how clinical systems and EMRs are used.
Says Erica Drazen, "One of the hottest areas is the development of tools for patient self-management. We've always recognized that (EMR-enabled tools) are very good tools for managing patient care and for making office visits more efficient, and for doing things like telephone visits and e-visits." Boston-based Drazen, a vice president in the Emerging Practices division of Long Beach, Calif.-based First Consulting Group, adds that any tools that help patients electronically report their vital signs and symptoms and that encourage care and monitoring outside the inpatient setting, will be hot going forward.
What's more, she says, health plans are "pretty much insisting" that providers move forward in that area. The pay-for-performance movement, too, Drazen notes, will further accelerate the EMR push. "When you're actually paying for performance, you've got to make sure those measures are really accurate."
The takeaway for CIOs in all this? "Right now, CIOs are still looking at things from the inside out," says Dave Dimond, a senior vice president at the Technology Solutions Company consulting firm, Boston. "But they really need to start looking from the outside in, because there's pressure developing" for them to put all the pieces together to facilitate clinical care in the future.
Mark Hagland is a contributing writer based in Chicago.
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