The Promise and Peril of Electronic Health RecordsCari WeishaarFinal Project12/8/11

Health care costs are too high…

United States

Netherlands

France

Germany

Denmark

Canada

Switzerla

nd

Austria

Belgum

New Zeland0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

2009 Total Health Expenditure as % of GDP

Source: OECD 2009

…and quality metrics are not better than other countries…

“…IT must play a central role in the redesign of the health care system if a substantial improvement in health care quality is to be achieved in the next decade.” - Institute of Medicine, Crossing the Quality Chasm 2001

Benefits of EHRs

• Safety – Decision support tools can prevent adverse drug events caused by mistakes in prescribing• Efficiency – Patient information is better tracked

thereby preventing redundancy of tests and procedures• Effectiveness – Automated reminders can make

physicians and their patients more compliant with treatment plans and preventative care recommendations

EHRs are made of many silos…Electronic Medical Record

Legal Record of Pt

Encounter

Practice Management

System

Appts

Billing

Decision Support Tools

ePrescribing

Labs and Procedures

Patient Portal

Encounter Summary

Secure Emailing

Lab Results

…with only one interface.

EHR Interface

EHR Interface

Interoperability

Legal Record of Pt

Encounter

Appts

Billing

ePrescribing

Labs and Procedures

Encounter Summary

Secure Emailing

Lab Results

EHR Adoption Rates Among Physicians

Why aren’t adoption rates higher?• Misaligned incentives• Cost are incurred by the individual practices, benefits are diffuse• EHRs are expensive to maintain

• Resistance to change• Learning to use the system is time consuming• Clinicians don’t want to be data managers!

• Uncertainty about the future• Standards are still evolving • Too many choices (83 CCHIT certified Ambulatory EHRs in 2011)

Appendix

HITECH Funds• Incentive payments for meeting “meaningful use”• ePrescribing• Electronically exchange information• Clinical quality measures

• Reduced Medicare/Medicaid reimbursement by 2015 providers who do not meet meaningful use

• Finding for education, training and research

Small practices are lagging1 phys

ician

2 physici

ans

3 to 5 phys

ician

s

6 to 10 phys

ician

s11 to

25 physici

ans

More

than

25

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Physician EHR Adoption Rates (July 2011)