Recently, I was talking with an internal medicine leader in a university health system who’s seen a lot of Health IT options come and go. Our conversation was lively and covered a lot of interesting topics, but one of his comments was particularly memorable.
The physician was talking about his struggles with previous EHR installations and venting a bit of frustration about the ground-up work his employers had to do to customize them. “It’s 2019 and there are EHR protocols and best practices that work,” he said. “Why should we have to start from scratch?”
I thought about his comments today when I came across the following research paper, which describes a study of the adoption of advanced HIT options by hospitals and health systems. It, too, seems to have concluded that a lot of the success of EHR deployments relies on tried and true practices.
The paper, which appears in the American Journal of Managed Care, outlines the results of a study looking at the characteristics of health systems which embrace advanced HIT capabilities versus those that don’t.
To conduct its analysis, the research team used responses from the 2017/2018 National Survey of Healthcare Organizations and Systems, a study backed by the Dartmouth College Center of Excellence, the University of California at Berkeley, Harvard University and the High Value Healthcare Collaborative.
Researchers used the data to assess the degree to which some key variables impact the adoption of 5 advanced HIT capabilities, such as predictive analytics and patient access to records. These variables included health system organizational structure, EHR standardization and resource allocation practices.
The analysis concluded that adoption of advanced HIT capabilities within the health systems studied was relatively low and varied meaningfully between systems.
For one thing, they found that only 8.4% of systems reported widespread adoption of all 5 capabilities, with a mean of 2.4 capabilities adopted. In addition, the research team also concluded that EHR standardization was the strongest predictor of the number of advanced HIT capabilities adopted, though the ownership and management of medical groups was also a significant predictor.
In the paper’s discussion section, the authors cited several reasons why standardization may be more closely associated with advanced HIT adoption than resource centralization. One that struck me as particularly noteworthy was that the adoption of advanced HR capabilities may be more of a change management issue than a problem of resource allocation.
Put in less academic language, the authors seem to be suggesting that change management skills seem to trump big budgets when it comes to succeeding with advanced HIT tools and capabilities. This conclusion doesn’t square with my anecdotal experience, but it is worth considering. After all, it would be good to think that well-managed health systems can truly do more with less.