EMR Adoption and Health Information Exchange

The last few years have been monumental for health. Electronic medical records have flooded into the mainstream with a recent report from Center for Disease Control (CDC) suggesting that nearly 55% of physicians in the US are at some stage of adoption. The survey also indicated that most respondents felt that EMRs had improved the overall quality of care. Industry analysts view this as a huge achievement for the healthcare industry and a giant leap towards the reformation process. One industry expert says, “The EMR has the numbers now. With more than half of the physician populous already using electronic medical records, physicians still using paper will have to join in or risk becoming obsolete.”

The U.S has been quick to utilize emerging technology in healthcare and with EMR adoption on the rise, physicians are likely to respond positively to innovation. “Our objective is connecting care and to reach this goal, we require an electronic health information exchange platform. EMRs provide just that”, says a hospital administrator.

John Lynn from healthcarescene.com shared a similar opinion in his blog. He believes that most of the healthcare community is aware of the benefits of Health Information Exchange (HIE). John argues that while standardization and development costs are two main barriers, the scale of EMR adoption in the country may be the biggest impediment to growth in the sector, he writes, “We want HIE’s to be successful, but can an HIE be really successful for doctors and hospitals that don’t have an EHR? The lack of EHR adoption might be the biggest impediment to HIE.”

The transformation of the healthcare system hinges on the success of electronic medical records. Having realized the importance of EMR adoption, the government extended its support through Regional Extension Centers and other educational communities in various states. The ONC highlighted the need for outreach programs targeting the rural and underdeveloped areas. While cost is a major deterrent here, education and exposure are the other key constraints.

The CDC survey also listed solo providers as the laggards in the adoption cycle, with only 30% reporting for adoption. However, the outlook is not so bleak. An industry expert highlighted that it’s common for independent businesses to lag behind in industrial changes, saying, “The adoption may be slower for independent doctor offices but it would change in the long run. Physicians are likely to follow large health corporations and hospitals in adoption. In fact there is an increasing trend of independent doctors adopting EMR systems with an HIE interface with their local hospital.”

HIEs are a step in the right direction and should help reduce cost in the long run. The communication process will simplify and health organizations will be able improve the patient care process through coordination. EMR adoption will continue to be the top priority and the government remains optimistic as it aims to shift America to electronic medical records by the end of 2014.

Read more: Data migration: Why is it important in Healthcare?


The Healthcare Reform – Are We There Yet?

The progression in health IT is introducing a new culture of care across the US. Developments in the world of technology have paved the way for a fluid and pro-active healthcare system.  “The pace of technological advancement in health IT has been incredible. We have witnessed a significant change over the course of a few years.”, says Josh Andrews a health IT analyst. Josh elaborates that the transformation of the healthcare industry within the US has come about rapidly saying, “While the health IT phenomena is worldwide, the growth rate across the US has been unprecedented. Our EMR adoption rate is extraordinary, having doubled from 2009 to 2011 and this is likely to increase in the coming months.”

However, this exponential growth presents new challenges for providers and regulatory bodies alike. Mark Kadrich, a security expert and the author of Endpoint Security explains that, the shortening of the testing phase to push technology is likely to give rise to multiple threats in the long run. 2011 was a huge year for mobile health with a lot of tablets and alternative devices being launched one after the other leaving the EMR industry to follow suit. Majority of the EMR vendors created non-native, remote desktop interfaces to grab a quick market share. However, in most cases these solutions were not practical and lacked maturity as Kadrich explains, “Mobile applications linking medical workflow between clinician and patient aren’t quite there, yet. There are some, but they’re rife with flaws.”

The healthcare system requires sustainable technology to grow and poorly developed systems will only hamper progression while compromising patient safety. There is a clear gap between the actual and expected capabilities of EMRs, in terms of interoperability. This is the reason that most medical professional were aghast upon learning the proposed requirements of the meaningful stage 2. “Our systems are incapable of connecting with hospitals and we still have issues with lab integration and e-prescribing.”, says a new EMR user.

The Health Information Exchange initiative (HIE) has shown remarkable growth and potential but the HIE industry itself is still in its adolescent stage. Only a handful of HIEs have been able to resolve technical issues. Exchange of medical information will pose significant risks that need to be addressed before commercial use. However, there is much optimism surrounding the development of HIEs.

Security is a huge concern for the health IT industry. With countless mobile and connected medical devices coming out, developers cannot ignore the need for improved security measures and better system design. The reason we are seeing an increased activity on the part of the federal government for system abuse is because our current healthcare system is arguably immature. Fraud and abuse are huge concerns for CMS as bugs in the systems are likely to be exploited. According to Kadrich, traditional methods will no longer be adequate, “We need to get beyond the traditional throw it behind the firewall’ mentality and take a good hard look at some new and innovative ways to fix things.”


The Incremental Approach Towards HIEs

Connected healthcare is a maze of landmines to be trodden lightly. Micky Tripathi CEO of the Massachusetts eHealth Collaborative points out in his recent article, the dangers of overbuilding HIEs. Although, this is not the first attempt at healthcare information exchange (HIE) as Micky has referred to the publicized failure of Santa Barbara Care Data Exchange and the ill fate of Community Health Information Networks in the 1990s. “I’m delighted that we’re moving rapidly in this direction, but one concern keeps nagging away at the back of my mind, and that is the propensity to pursue over-architected HIE solutions”, he says.

The problem lies with the ideology of constructing a comprehensive solution that is capable of handling inter-industry information exchange, along with providing electronic support to remote clinical sites which themselves are a mere concept for now. What the government must understand is that the process cannot be sped up to reflect drastic changes and thus must follow a natural course. Incremental changes will allow the industry to respond appropriately while developing sustainable solutions that can be built from the ground up. Forcing instant change will not yield the benefits attributed to a HIE.

EMRs have been a prime example of why there is no single pill solution. Despite the rapid development in the industry, EMRs have not attained a form that could be considered complete in any regard. The world of technology is ever developing and nothing can truly be a final form. Changes are likely to occur as usability increases. While we may have a general idea of the risks associated with information sharing and health networks, actual usage will be more likely to shape a sustainable design.

The HIE infrastructure is still in its infancy whilst most practices lack the resources or adequate training to support the transition. However, it is expected for the industry to develop substantially over the next few years, with the private sector likely to lead the charge. A recent report by Chilmark Research highlighted the phenomenal growth in HIE(s) during 2011, increasing to a colossal 40% per annum.

HIEs can change the landscape of healthcare and while Accountable Care Organizations may be the initial goal; HIEs will inevitably shape a new world of care delivery.


HIE Integration – Why is it Necessary?

The goal of health information technology (HIT) is to improve the availability of information to clinicians at the point of care. The two most significant components in the HIT infrastructure are electronic medical records (EMR) and health information exchange (HIE). Together, these technologies will be the major disrupts in the health care industry over the next five years. Most health care providers are already aware that they must have an EMR with HIE integration in order to achieve meaningful use, start an Accountable Care Organization, or participate in a medical home model; however, adoption remains low while resistance remains high.
Information Availability with EMR

While healthcare IT executives applaud the benefits that HIE can provide, such as improving the quality of clinical reporting and the coordination of care among physicians, the high costs of participating in an HIE is still an impediment. A recent study found that 41% of physicians consider high start-up costs and insufficient capital to support HIE as their major concerns. Additionally, 38% said they have annual budgets for HIE development of less than $1 million, while 21% have no budget at all.

There are several implementation issues with HIE integration as well. Currently, because there is not one single set of standards consistently implemented, a custom connection has to be developed from each EMR to each HIE. The development of the interface represents a significant expenditure of cost and time for all stakeholders, including physicians and vendors, which has been limiting both adoption of EMR and the usage of HIE services.

Regardless of the foregoing problems, we cannot deny the substantial albeit unforeseeable benefits on the EMR/HIE horizon, especially if we look at precedent-setting examples. HIE is the most significant transformational tool healthcare has seen since advanced imaging, and the benefits will lead to tremendous improvements in treatments and outcomes. Stakeholders will soon face a much bigger stick than competing in the market to answer the health care equivalent. Patients and physicians will demand more efficient information exchange through a multifaceted approach that will create unprecedented resource disruption and, ultimately, higher costs to the stakeholders that continue to lag behind.

At present, 90% of patient health information resides in private practices within any given community. This is a staggering number considering the fact that there is no efficient way to transition and coordinate care between health care providers. The gradual but steady adoption of EMRs is a step in the right direction for improved workflow and quality of patient care. The next step is for physicians to realize the value of being able to efficiently transition care and the information that is associated with this process. The idea of a fully functioning national HIE may seem farfetched, but then again, there are substantial grounds to continue its development.