Lackluster EHR adoption, interoperability & usability prevent cost savings

Where are the savings? EHR and other health IT tools were supposed improve healthcare productivity and efficiency to reduce costs, but several barriers still stand in the way, according to research published in the January issue of Health Affairs.

Prior to passage of the HITECH Act, multiple research projects concluded that significant savings could be achieved through the adoption and utilization of health IT. A 2005 study conducted by a team of RAND researchers estimated that health IT could save the healthcare system around $81 billion annually. Seven years later, efforts to measure savinds attributable to health IT have yielded mixed results.

Despite the mixed results, Arthur L. Kellermann, a RAND policy analyst, and Spencer S. Jones, a RAND information scientist, still believe the potential is there. However, the design of implementation of health IT systems is preventing that potential from being realized.

“The anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master the difficult-to-use technology and the failure of many healthcare systems to implement the process changes required to fully realize health IT’s potential,” Kellermann and Jones wrote.

One reason cost savings haven’t been achieved is because EHR adoption hasn’t occurred quickly enough, according to Jones and Kellermann. The 2005 RAND study assumed an adoption rate of 90 percent to reach $81 billion in annual savings. While Meaningful Use incentives have driven adoption higher, there are still only 40 percent of physicians and 27 percent of hospitals using a “basic” EHR system. Adoption rates among rural hospitals and smaller physician practices is even lower.

The current generation of EHR systems also fail to deliver in terms of interoperability, functioning “less as ‘ATM cards,’ allowing a patient or a provider to access needed health information anywhere at any time, than as ‘frequent flier cards’ intended to enforce brand loyalty to a particular healthcare system,” according to Kellerman and Jones. Information stored within an organization’s EHRs is often useless if a patient seeks out-of-network care. Even if another organization uses the same vendor, the degree of local customization often prevent the systems from communicating with one another.

Another reason health IT hasn’t delivered saving is because clinicians aren't using them effectively, according to Kellermann and Jones. Usability has simply not been top priority for EHR vendors.

Moving forward, Kellerman and Jones said efforts to facilitate savings through EHRs should focus on interoperability, patient-centeredness and ease of use, but larger adjustments to the healthcare system will also need to be made.

“Fully interoperable, patient-centered and easy-to-use systems are necessary but insufficient to unlock the potential of health IT,” they concluded. “Ultimately, there is only so much that the government and vendors can do. Providers must do their part by reengineering existing process of care to take full advantage of the efficiencies offered by health IT. This revamping of healthcare delivery is unlikely to happen before payment models are realigned to favor value over volume.”