Supply chain investment by CMS enables widespread EHR adoption
By sharing in the costs, the Centers for Medicare & Medicaid Services (CHS) has created an environment where widespread adoption can occur, according to Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.
When the internet and affordable personal computers opened the ambulatory EHR market in the 1990s, established vendors were unprepared to meet its unique needs, according to Tripathi. Hospital EHR systems, first implemented in the 1990s, were essentially “electronic filing cabinets,” and electronic documentation was primarily the responsibility of support staff and not physicians. Smaller staffs and budgets in ambulatory spaces meant workflow, user-friendliness, billing functions and interoperability were especially important.
“EHRs at the time were basically electronic versions of paper records, which mimicked the diverse and idiosyncratic record-keeping approaches that were a hallmark of narrative- and dictation-focused paper-based systems,” Tripathi wrote in the October issue of the Journal of the American Health Information Management Society. “These EHR systems didn’t really unlock the unique capabilities for data management, presentation and analysis.”
EHR adoption remained low, despite technological advancements. Individual providers and organizations developed separate care and data storage processes and vendors tried to accommodate disparate needs by building EHRs that forced paper-oriented workflows into computer-based systems rather than focusing on usability, standardization and interoperability.
“EHR systems were not getting standardized because their users were not standardized,” Tripathi wrote. “As the healthcare industry continued to practice medicine like guilds of independent craftsmen and artisans, they insisted that their tools be custom-crafted as well, which made it impossible for the industry to reap the benefits of economies of scale that have driven high penetration of IT in other parts of the economy.” Additionally, “while the additional costs of fully functional EHRs were borne largely by clinicians, the incremental benefits flowed largely to others, such as public and private health insurers, employers and ultimately patients.”
The HITECH Act sought to solve this problem by having two large health plans, Medicare and Medicaid, share in the costs of implementation through the Meaningful Use program. This sort of of supply chain investment has worked before, Tripathi noted. Wal-Mart wasn’t able to get its suppliers to adopt RFID technology until it adopted a cost-sharing approach.
Now, CMS is basically acting as a single customer to create economies of scale and demands long-absent EHR standards and features, including:
It is unlikely that the EHR Incentive Program will result in plug-and-play systems by the time Stage 3 is complete, but it is creating a “common floor of capability across vendor systems,” Tripathi wrote. “How much of the EHR evolution would have happened without the intervention of HITECH is hard to tell, but without it, the changes certainly wouldn’t have happened with the speed and focus that the industry has witnessed to date.”
When the internet and affordable personal computers opened the ambulatory EHR market in the 1990s, established vendors were unprepared to meet its unique needs, according to Tripathi. Hospital EHR systems, first implemented in the 1990s, were essentially “electronic filing cabinets,” and electronic documentation was primarily the responsibility of support staff and not physicians. Smaller staffs and budgets in ambulatory spaces meant workflow, user-friendliness, billing functions and interoperability were especially important.
“EHRs at the time were basically electronic versions of paper records, which mimicked the diverse and idiosyncratic record-keeping approaches that were a hallmark of narrative- and dictation-focused paper-based systems,” Tripathi wrote in the October issue of the Journal of the American Health Information Management Society. “These EHR systems didn’t really unlock the unique capabilities for data management, presentation and analysis.”
EHR adoption remained low, despite technological advancements. Individual providers and organizations developed separate care and data storage processes and vendors tried to accommodate disparate needs by building EHRs that forced paper-oriented workflows into computer-based systems rather than focusing on usability, standardization and interoperability.
“EHR systems were not getting standardized because their users were not standardized,” Tripathi wrote. “As the healthcare industry continued to practice medicine like guilds of independent craftsmen and artisans, they insisted that their tools be custom-crafted as well, which made it impossible for the industry to reap the benefits of economies of scale that have driven high penetration of IT in other parts of the economy.” Additionally, “while the additional costs of fully functional EHRs were borne largely by clinicians, the incremental benefits flowed largely to others, such as public and private health insurers, employers and ultimately patients.”
The HITECH Act sought to solve this problem by having two large health plans, Medicare and Medicaid, share in the costs of implementation through the Meaningful Use program. This sort of of supply chain investment has worked before, Tripathi noted. Wal-Mart wasn’t able to get its suppliers to adopt RFID technology until it adopted a cost-sharing approach.
Now, CMS is basically acting as a single customer to create economies of scale and demands long-absent EHR standards and features, including:
- A core of consistent, structured, clinical content;
- Automated alerts and reminders;
- Quality measurement capabilities;
- Data mining capabilities;
- Public health reporting; and
- Interoperability.
It is unlikely that the EHR Incentive Program will result in plug-and-play systems by the time Stage 3 is complete, but it is creating a “common floor of capability across vendor systems,” Tripathi wrote. “How much of the EHR evolution would have happened without the intervention of HITECH is hard to tell, but without it, the changes certainly wouldn’t have happened with the speed and focus that the industry has witnessed to date.”
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.