EHR Adoption Will Be Slowed Significantly by HITECH

I recently posted what I think is a relatively reasonable timeline for EHR adoption. It’s very broad, but I think that most doctors could use it as a reasonable estimate of how long it will take to implement an EHR or EMR in their clinic.

Of course, the above EHR implementation timeline doesn’t start until a doctor or clinic makes the decision to actually implement an EHR in their clinic. Unfortunately, I’m afraid that HITECH is going to dramatically delay many doctor’s decision to implement an EHR.

The HITECH act just gave doctors who were on the fence about implementing an EMR will now have a bunch of great excuses why they should wait longer to implement an EMR:

  • We need to know what certification criteria is chosen by HHS
  • How will HHS define meaningful use? Will we even be able to show that?
  • Will our preferred EHR be able to satisfy the HITECH act reporting requirements?
  • Let’s wait to see what open source EHR HHS gives away

I’m sure there are other reasons. While I’d usually say that these were just excuses for people who don’t want to use an EHR, I actually think this is probably the best plan for those looking to implement an EHR. I don’t think I’d be signing any contracts with a vendor right now. Unless I didn’t care about getting the EHR stimulus (which might actually be a good line of thinking).

What shouldn’t be delayed is the evaluation of the various EHR on the market today. In fact, I highly suggest this evaluation takes place before HHS defines the above items. EHR stimulus money should not be a major factor in your EHR selection process, but instead should be an added side benefit or a tie breaker for 2 equally great EHR companies.

Certainly some will argue that some doctors will be motivated by the HITECH act to implement an EHR quickly in order to receive the EHR stimulus that begins in 2011. Doctors who can’t show meaningful EHR use by 2011 could possibly miss out on the medicaid and medicare bonuses. I just honestly don’t think that most doctors will care that much about it.

Those who would have been proactive in implementing an EHR because of this already have an EHR and are just licking their chops at the idea that they might get some extra money from government for little additional work. I don’t see many of those who haven’t implemented an EHR being that motivated by a few thousand possible government dollars.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

17 Comments

  • 5/14/2009

    More reasons not to impliment a c-EHR:

    2) Medicare just announced that they are going out of business in 2017. Why buy a ticket on the Titanic if you already know that it’ll sink?
    3) The total 5 year cost of implimentation will be about $300000.00 (using conservative data). Ref- http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate
    4) I studied medicine to be a physician, not a secretary.
    5) The mandatory activities are unnecessary and will slow me down considerable, making the practice of medicine less profitable overall (s.a. eRx vs paper Rx).
    6) I find most of the HIT mandates, both brought forth by Bush and Obama to be driven by HIMSS/EHRA lobbying than by true altruistic motives.
    7) When they put forth a study that shows that a c-EHR can not just improve quality, but improve it as compared to paper or a simple EMR looking at the same quality measures, then I may come around.
    8 ) Even better- they need to show an increased survival benefit. It’s not good enough to simply show that smoking cessation was discussed. They also have to show that patients reacted to the intervention AND that there was less morbidity and mortality. The only study showing an increased mortality that I’ve ever run across was the one in a children’s hospital where a c-EHR ended up leaving an increased ratio of dead children.

    Whew! Those are the only ones that I can come up with on the top of my head, John. For now, I’ll keep using my simple MS Access-based EMR.

    Al

  • Interesting list of points. Definitely things that doctors should consider when looking at EHR adoption.

    I’m not sure you have such a “simple” MS Access-based EMR. I have a feeling that you’re much farther along in EMR use than most people. I’d be happy if all doctors were as proactive as you in learning about EHR adoption. Then we’d see a real change in EHR adoption.

  • Glad to see that you’re at least showing your biases. Now if only our politicians were willing to show their biases. I’m all about full disclosure.

  • Another reason for physicians and hospitals to wait is that current EHRs do not currently have the functionality to comply with the privacy/security requirements of the HITECH Act. Under HITECH, if a covered entity uses an EHR, it must provide access to patients (or to someone designated by the patient) to their designated record sets in electronic format if requested by the patient. Not many EHRs have the functionality to do that. And that’s one of the simpler of the new requirements.

  • Jana,
    I really need to look at some of the new HIPAA requirements. An important question is who would these requirements apply to?

    As far as the specific requirement you talk about, couldn’t most EHR just print the record to a PDF file and make that available to the patient?

  • […] EHR adoption has been really slowed by the passing of the $18 in EHR stimulus money. However, that doesn’t stop the EHR companies from doing everything they can to get doctors to purchase an EHR now. Here’s a couple of examples of what EHR companies are saying to try and get doctors to purchase their EHR. Of course, I’ll add in my thoughts after the reasons to buy an EHR now! […]

  • As a Heath IT Provider, I have personally seen the impact on the coversion to EMR. It is a long and difficult process, but in the end, creates a management system for the doctors office to keep track of all medical records, billing, front and back office. Since most doctor’s office staff have considerable turnover, having a good management and ERM equates to higher re-embursements and better accountablility.

  • Gary,
    Implementing an EMR definitely takes a long term perspective to see the real financial benefits. However, there are short term gains such as legibility and access of patient charts. Those are just not financial.

  • I just wanted to note that it’s very likely that your simple MS access database is not 21CFR11 compliant nor compliant under HIPAA’s privacy part. If you are ever audited you will probably face significant fines for storing PHI in a non-compliant fashion…

  • Hi Ben:

    Actually, my MS Access EMR is not that “simple”… it’s just inexpensive. It has a total of about 800 reports and forms with about 150 backend tables. It does EMR, PMS, and even helps me with my chemotherapy. All this, yet it fits all my 10000 patient information into a thumb drive which works using the already installed MS Office program in most of my 2 hospital’s computers.

    It is password protected, has an audit trail scheme, and my small office’s computers are all similarly password protected. My wireless is WEP key protected. I give all new patients the usual HIPAA privacy paperwork that they have to sign when in the waiting room. My electronic billing is sent through a secure line to Office Ally (faxing or email is not allowed). That said, since I use a “hybrid” system, my paper documents can be considered to be the authoritative document for regulatory purposes and the computer system need not meet the the FDA 21CFR11. (URL: http://en.wikipedia.org/wiki/Title_21_CFR_Part_11 )

    But really- do you know of one case where the FDA actually went after a 21CFR11 noncompliant EMR? The rules are a figgin joke, Ben, and you know it. Since 2007 broad sections of the regulation have been challenged as excessive, and the FDA has stated in guidance that it will exercise enforcement “discretion” on many parts of the rule. Read: the rule is so onerous that it is essentially unenforcable.

    Same goes for the HIPAA rules. We all spend so much effort and time to comply, yet the handful of cases arise when a disgrunted, recently fired employee becomes a whistleblower to screw their past boss and “tells all” to the feds who then pounce on the poor unsuspecting doctor to showcase their enforcement muscle. I’ve heard of anecdotal cases s.a. this, but I have never actually seen an office raided for an HIPAA violation or a major article on the subject in my medical journal reading. Considering that, if say, there are a dozen cases, then 12/780000 practicing doctors, my chances of an HIPAA audit are about 0.002%.

    What has been hot of late is the HHS and feds going after reports of deaths and other negative issues associated with “enterprise” Obama-HITECH ready EMRs failing. Check out: http://www.massdevice.com/news/blumenthal-evidence-adverse-events-with-emrs-anecdotal-and-fragmented Maybe we all need to switch to “simple,” or in my case, less expensive self-made, hardy, easy to use, powerful, fantastic EMRs with a great interface. ;^)

  • Oh- about my last paragraph… read this Huffington Post article:

    “FDA evidence shows the downside of poorly implemented CPOE,” http://www.fiercehealthit.com/story/fda-evidence-shows-downside-poorly-implemented-cpoe/2010-04-26

    Yup, I see this as a push back to “Fred Flintstone” era EMRs… without the dreaded CPOE, eRx, HITECH reporting to HHS, quadruple password protection, and worse yet- the average $33,000.00 up-front price tag with $1800.00/mo ongoing fees. All of these features simply add a layer of bureacracy and complication that ends up in increased errors, increased morbidity, increased mortality, and of course in increased overall cost of health care.

    Great rant, huh?

  • Long time reader and lurker. Enough problems have been created by this technology for it to be avoided. As an advisor to medical groups, I maintain a wait and see approach. Until there is accountability, transparency, and integrity of processes to assess these care altering systems, it is sound strategy to not buy at this time and to pressure hospitals to be careful not to put patients at risk with certified but not FDA approved equipment.

  • Al,
    Interesting stuff. I knew you’d enjoy responding.

    Patricia,
    Do you really think that an FDA approved EMR is going to improve things in the EMR world?

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