Industrywide EMR adoption accelerates as barriers are overcome

There are indications that the industrywide adoption of electronic medical record (EMR) technology has begun to move forward at something more than the glacier-like pace of the past few years.

According to a recent survey of more than 200 U.S. healthcare executives, nearly 25% of hospital leaders reported that their institution has a fully operational EMR system (EMR being defined in the survey as a record that maintains a patient's "lifetime health status in a completely paperless fashion"). According to the survey by the Healthcare Information and Management Systems Society (HIMSS) released at its annual conference last month, that figure was at less than 20% both of the last two years.

In addition, the survey said that about 40% of U.S. hospitals have either initiated installation of an EMR system or contracted out to have one installed. About 25% of respondents said they plan to implement an EMR but have yet to begin.

While these signs of progress are good news for advocates of EMR systems, there is obviously much more progress to be made before the U.S. healthcare industry moves fully away from paper records. And, say many industry observers, it's the practitioners who are the hardest to convince that EMR is the way to go with more emphasis needed on small-group and solo practices that traditionally have been reluctant to computerize their medical records.

But even that view is changing.

"As we move in this journey toward automation, physicians are often spoken of as being a barrier to progress," says Manuel Lowenhaupt, MD, leader of the clinical transformation practice for consulting firm Accenture's Health and Life Sciences division. "But I see it more as a disconnect between those who invest and those who benefit from EMR. We ask doctors to invest time and money in EMR, but the most obvious beneficiaries today are the health plans and the government. I don't think of providers reluctant to invest in EMR as being barriers to progress. Rather, it's more like there's a disconnect between the benefits EMR offers and the doctors being asked to bear the investment."

Dr. Lowenhaupt says that while there are definite benefits that EMR can bring to even small-group and solo practices, they can be subtle and are clouded both by physicians' self-perception and by the fact that they tend to focus so intently on patient care, that the business side of their practice is of relatively low priority.

"We know that EMR can be a powerful tool to minimize medical errors, and all doctors want to do that," he says. "However, recent surveys show that doctors tend to underestimate the fact that they can create errors. This is an area we need to focus on in terms of showing doctors the value of EMR to better-quality patient care and convincing them to adopt it."

Moreover, Lowenhaupt says, physicians need to be convinced that electronic attachment to claims through an EMR system can cut down dramatically on lost charges. When that happens, the benefits to both payers and doctors will be more aligned.

The pay-for-performance (P4P) concept already has begun to do this, Dr. Lowenhaupt says. "We are beginning to see financial incentives, whereby doctors are rewarded for having EMR systems," he says. "We have to do more of what other countries are doing. In the United Kingdom and Sweden, for example, about 80% of primary-care doctors are using EMR because the government helps subsidize its purchase."

Says Peter Waegemann, CEO, of Boston-based Medical Records Institute: "It probably will be small practices that will push the healthcare industry to go to EMR, and that's totally opposite of what most observers tell us," he says. "Once we get 25% of these practices using EMR, industrywide adoption will accelerate rapidly, and I see that happening within the next three years."