Challenges and successes of EHR adoption

CHICAGO--In a presentation at the Human Factors and Ergonomic Society’s 2014 Symposium on Human Factors in Healthcare, Abel Kho, MD, MS, presented an update on the successful adoption of and challenges to implementing EHRs across the different regions of the country and locally in Chicago, as well as current rates of Meaningful Use (MU) attestation.

Regional Extension Center (REC) programs were created by the Office of the National Coordinator for Health Information Technology (ONC) as a response to the challenge issued by President Obama to ensure that all Americans have access to an EHR by 2014. ONC established 62 RECs across the country that assist primary care providers in the adoption and meaningful use of EHRs. The extension centers work to optimize the use of EHRs so that providers can become meaningful users, engage in new healthcare transformation and quality initiatives and participate in payment delivery reform programs, such as accountable care organizations, Comprehensive Primary Care Initiative, state innovation models and others.

Kho is co-executive director of the Chicago Health Information Technology Regional Extension Center (CHITREC) located at Northwestern University. CHITREC’s focus is to help Chicago become a leader in the development and advanced use of health IT. Kho reported that to date, CHITREC has enrolled 1,797 providers in the program, meeting its goal by 121 percent. Of those, 1,741 providers are live on an EHR system, and 79 percent, or 1,172 providers, to date have achieved MU. Kho reported that 70 percent are Medicaid providers.

Challenges to Progress

According to Kho, the next step is to optimize the use of these EHRs to communicate information and collect data. He noted that one of the biggest challenges to this is interoperability among different EHRs.

“We have an infrastructure where we have EHRs across the city. How can we make them work together now for quality measurement across the population?” Kho said.

Some of the immediate challenges to progress include basic interoperability among EHRs, the imminent ICD-10 coding conversion, and lastly, clinical quality measures. Kho is specifically interested in defining and measuring clinical quality in CHITREC. As a physician, he said, after you install your EHR and go live, you want to know how you’re doing compared to everyone else. This information is currently not available. Quality measures differ among the various EHR vendors and this will present a problem in the long run.

Many of the clinicians in attendance were interested to hear Kho’s update on MU, and specifically, any refinements to quality measures. Kho cautioned that current quality measures were not defined from the ground up, meaning that input data elements that would result in meaningful information were not considered in the development of most EHRs, and certainly not standardized, so that the information available as output is compromised and in effect, not meaningful.

“We have to be careful not to make these quality measures a false idol,” Kho said. “Unfortunately, with all the different vendor products collecting different information, you don’t get something you can measure across the entire population. From a data perspective, it’s junk in-junk out.”

Meaningful Design

In addition to the work enrolling providers at CHITREC, Kho has a specific interest in usability and works with firms that specialize in user experience. As part of his work with CHITREC, he advocates widespread adoption of EHRs but he takes a step further, and stresses that in order to promote the continued use of EHRs and to receive the full benefit of the products’ capabilities, physicians should find them easy to use. He notes that to date, that is not the case.

In a recent study, Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, published by the Rand Corporation, one of the key findings of physician dissatisfaction was regarding EHRs. Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.

With the mad rush to get everyone live on an EHR by 2014, it seems that the usability component was overlooked. Many vendors are now going back to restructure their designs to include more usable functionality for physicians. As part of MU legislation, there is now a usability requirement in order to meet attestation.

“We are in an exciting place today with a lot of opportunities for new developments” said Kho, stressing opportunities for new design and fluid interoperability. “EHRs are great, but not used as meaningfully as they could be. We need to get to a place where we can normalize the data that is collected. Each vendor makes its own EHR, but under the hood, they all need to work together,” he concluded.