Hospital EHR Adoption Chart

I always love a good chart and this one illustrates what those of us in the industry have know for a while. EHR incentive money absolutely increased EHR adoption in hospitals. I think it also did in ambulatory environments as well, but not quite to the extent of hospitals.

Can we just put the discussion of whether HITECH helped EHR adoption to rest? It increased EHR adoption.

To me that’s not the question that really matters. What really matters is whether the EHR incentive money has incented adoption of the right EHR software. It’s great that we’ve adopted EHR software, but have we just locked ourselves in to the wrong software for the next 5+ years? Or have we implemented a great EHR foundation that will prove to be extremely beneficial to healthcare for decades to come?

I look forward to a deep discussion in the comments.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • No doubt it increased EHR adoption. But it was an artificial market. And all artificial markets fail. Typical of any government program they wanted to encourage EHR but have to show that people are meaningfully using the money. So they did what they thought was right, dozens of measures, objectives, etc that show the auditors that the money is appropriated correctly. But as always, they over reached. They kept piling on stages, measures objectives, all with very little time to allow learning, workflow changes, software updates, etc. And typical of any government program, the folks placed in charge of deciding what MU is, had this fantasy that one size fits all practices. MU required 100% passage of all the measures/objectives or your fail. Further, the difficulty of understanding the specifics to attain the percentages, numerators, denominators, attesting, auditing, etc has obviously become blindingly complex. And those in charge of making the rules, have been increasingly tone deaf to the front line street level provider. They have placed the EP in the untenable place of having software that is just too laborious to use. ONC needed to step back and ease back, but they went the opposite and piled on the burden. Hence, the flight from the MU program. Even the overachieving IT EP types have left the program. Worse while many EPs are just trying to stay afloat with MU and the massive changes with that. Somehow, our leadership, AMA, and others have allowed CMS and ONC to deluge EPs with an array of overwhelming programs, from MU to PQRS, CQM, VBM, MIPS, MOC, ICD-10, etc. We are literally drowning. So we do what anyone else would do, we give up. We just take the penalties, we stop participating and try to go back to what we do best, taking care of patients. All these other programs are distractions and really do not do anything to improve care. We learn how to game the system, to click here or there, just to get out of the storm of data entry, pop ups, clicks and documentation requirements. Sadly, EHRs in the current state are a massive mess for EPs. All available dollars and programming and development is forced to certification and all these complicated programs. EHRs could be an excellent resource for EPs, but now they are redundant, pre-populated templates that do not capture the real state of care and are prone to propagate mistakes within them, wide and far. EHRs were originally built for billing and the patient care portion is obviously just tacked on to that. You can tell that the flow of an EHR is hardly set up for actual patient care, its a billing tool with a lopped documentation system to capture charges.
    We use an EHR in our practice, its fully customized to our workflow, safety, security, usability all take precedence over anything else. Unfortunately, even though we incorporate nearly all the MU requirements, ours is not certified and its just too expensive to go through that program and the things we don’t need, like immunizations, etc. would never allow certification. So we take the penalty and happily do so. As we are far more efficient with our customized EHR than some MU prioritized EHR. But should we really be penalized? We are able to securely share data, etc. but in the eyes of ONC we are penalized, which I feel is wrong. Just imagine a world where EHR vendors do not have to worry about certification and they focus all their efforts on EPs usability, efficiency safety and security. Thats what we have. Its ideal.
    We let the market work for us, not some artificial market made by CMS and ONC.

  • If there were no penalties for non-EHR adoption, what would that chart look like?

    Ask the same question for the other mnenominc programs,PQRS, CQM, VBM, MIPS, MOC, ICD-10, etc.

  • Software vendor here: this poster is inspired. I’ve been in IT for
    40 years, installed hundreds of systems, developed thousands of programs. Got lots of doctors MU money.
    90% of it was a waste. IT systems are meant to serve the user, not
    the government bureaucracy.

    Primary physicians have 2 choices in today’s environment. One, go concierge. Of course only a limited number of physicians can do this. The second option then, needs to be taken by most, is to become more efficient. IT is a large part of achieving that.

    However, MU has accomplished the opposite. It has taken the only asset medical practices have, the time of the MDs, and wasted a good part of it, making their jobs more time consuming not less.

    I had a client call a couple weeks ago all bent out of shape about MU,
    PQRS etc. Turns out this client does zero medicare. I told him to
    be happy, he is completely free to do whatever he likes. A few small HIPAA issues to address, but that’s it.

    Best advice after Stage 1 – take the penalties for MU, do the minimum on PQRS. What this poster describes is exactly how IT should work in medicine (and all other businesses). Customize, adjust, implement, cost justify most efforts, be flexible – make IT pay for itself, not waste provider time so the bureaucrats can gather meaningless data and dictate how medicine is practiced.

  • “If there were no penalties for non-EHR adoption, what would that chart look like?”
    This sounds like a great future blog post. I’m going to queue it up.

    “Best advice after Stage 1 – take the penalties for MU, do the minimum on PQRS. What this poster describes is exactly how IT should work in medicine (and all other businesses). Customize, adjust, implement, cost justify most efforts, be flexible – make IT pay for itself, not waste provider time so the bureaucrats can gather meaningless data and dictate how medicine is practiced.”

    I like this advice. Might be too late for many people though.

  • Not too late. The penalty of using ‘make phys slower’ software is the gift that keeps on giving. I have seen clients and others simply decide that stage 2 is a step too far.

    If enough practices do this, the bureaucrats will back off.

    What’s more, the market may force it. What are these companies going to do now that the EMR feeding frenzy, pushed forward with MU money, is coming to an end. IT will have to go back to the old rules – cost justification.

    We are seeing practices leaving well known EMRs after the first 2-3 years of MU money has been received. Main reasons are inefficiency but also costs of ongoing support – which MUST rise or some companies will go away entirely.

    Even the bill/collect model is not going to provide the complete answer. The reimbursements are shrinking, the going rate for bill/collect is becoming very competitive (6% or less), the big companies do not follow up claims or patient statements, so practices still need a (smaller) A/R dept.

    Sadly, there are not enough quality people to do and support the installations properly. Companies with large overheads are going to struggle. marketing and sales are expensive, take money right off the top, and potential sales are shrinking.

    bottom line in all of this is the government wants fewer small practices. they cannot control small practices. if they get providers grouped up, (providers trying to be ins carriers and ins carriers trying to be providers), it will be easier to nationalize medicine. big practices suck up huge dollars in IT efforts, they create their own bureaucracies.

    its kind of a mess, but opportunities are still there.

  • Speaking of PQRS, why is the age cut-off for the diabetic group reporting 75 years? And, one of the Diabetic PQRS criteria is having 11 patients which must be Part B Fee-For-Service patients) to avoid the 4% penalty. I’ve treat a lot of diabetics greater than age 75, but they apparently don’t count. Go figue that one.

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