Pitiful (pĭt’ĭ-fəl) adj.
- Inspiring or deserving pity.
- Arousing contemptuous pity, as through ineptitude or inadequacy.
There have been several interesting reports that have recently been published regarding the adoption and use of Electronic Health Records (EHR) by our health care system. The articles provide an interesting contrast into the promise and potential of EHR’s but also the pitiful progress that we have made as a country in utilizing these tools.
First the good news. The most recent issue of Health Affairs higlights Kaiser Permanente’s experience with the largest civilian EHR implementation ever and the corrolating impact of extending that technology to its members.The article is impressive, and highlights the amazing work that Kaiser has done in impacting the clincial, financial, and administrative inefficiencies in their own system through the implementation of an comprehensive EHR. All the typical advantages that you would expect are highlighted but perhaps most interesting to me was the common theme of how effective and efficient the comprehensive system made the organization in delivery high quality care to everyone everywhere along the continuum. The relationship between physicians and patients was dramatically altered for the better, communication and trust improved, and overall satisifcation enhanced by both parties.
Kaiser is not alone in this, as other integrated delivery networks such as Geisinger and Intermountain have reported the same benefits. Kaiser to its credit, demurers their success by stating their efforts are “still in progress”. Furthermore, the highlight the unique aligned environment in which their integrated delivery network is optimized for effective and efficient care regardless of how the care is delivered. Therefore, for them, there is no economic disincentive to perform an email consult as opposed to an in person visit. The CBO has previously highlighted this key point by stating, “How well health IT lives up to its potential depends in part on how effectively financial incentive can be realigned to encourage the optimal use of the technology’s capabilities.”
Now the bad news. The august New England Journal of Medicine reports in their March 25 issue that less than 2% of US have a comprehensive EHR (defined clinical documentation, test and imaging results, computerized provider order entry, and decision support). Read that again – less than 2% of US hospitals have the essential tool that is required to practice best evidence, most efficient, and most effective health care. Is it any wonder that we have the level of errors, the lack of information, and the woeful inefficiencies in our health care system. Can you imagine any of our large retailers, financial institutions, or shipping companies having a 2% adoption rate of the systems absolutely required for them to compete? It is literally unbelievable.
Drilling down one layer, the reasons for lack of adoption were the common ones:
- Inadequate capital for licensing and implementation
- Inadequate capital for maintenance
- Physician resistance
- Unclear return on investment
- Lack of trained technical staff for ongoing system support
I could spend alot of time commenting on the above, particularly #3 and #4, which are completely unacceptable in my opinion. We certainly don’t see physicians resisting the latest CT, the latest surgical tool, or the most advanced pharmacologic agents in their management of patients. In fact, given the reimbursement system, we see their overutilization of these tools because they are paid to use them.
The article reaches this same conclusion and states that the health care financing system needs to reward hospitals and physicians for actually using these tools. This can be accomplished by incentives to implement, to report back on usage, and to receive higher compensation for managing populations effectively (most readily acheived by using the tool). Strong disincentives also need to be put in place for individuals not using these tools in the form of lower reimbursement and ultimately penalties for non-use.
While I cheer for the Kaisers of the world and all the other brave souls who have implemented comprehensive EHR’s, I also castigate the sloths who have failed to implement the tools and technology that are required to transition to high performing health care delivery organizations. I am hopeful that the TARP / ARRA pig trough can create the finanical realignment required to create the breakthroughs in health IT adoption that are so desperately needed.