Maybe We’re At Full EHR Adoption. What Now?

Today, I was looking at some statistics from the ONC on hospital use of EHRs. You won’t be surprised to hear that as of 2017, more than 95% of hospitals had an EHR in place.

Since vanishingly few technologies are ever deployed by all possible parties, it’s probably fair to call this full adoption, in much the same way that ”full employment” in the US includes maybe four or five percent of adults who aren’t on the job for one reason or another.

What do we do now? It’s a big important question that we’ve barely begun to address. I’d argue that we’re sort of post-adoption but haven’t yet moved into the “full EHR use” era either.

Don’t get me wrong — I’m not suggesting that hospitals are sitting on their hands. In the brief, ONC notes that public policy is now shifting towards the use of EHR data for patient care improvement. And indeed, their statistics show that 94% of hospitals were using this data as of 2017, for reasons that include:

  • Supporting quality efforts (82%)
  • Monitoring patient safety (81%)
  • Measuring organizational performance (77%)
  • Identifying high-risk patients (68%)
  • Creating individual provider profiles (67%)
  • Measuring unit performance (67%)
  • Identifying care gaps for patients (60%)
  • Assessing adherence to guidelines (59%)
  • Developing approaches to querying for data (51%)

The hottest trend among these seems to be the use of data to identify high-risk patients, the use of which grew 15% between 2015 and 2017, followed by identifying care gaps (12% increase), developing approaches to querying data (11% increase) and supporting quality improvement (11% increase).

That being said, however, uptake is lagging for some important functions, such as identifying care gaps. Also, we seem to be far from developing well-defined guidelines or use cases for performing these activities within hospitals. Want to deploy AI or a new flavor of predictive analytics? You may be on your own.

Unfortunately, healthcare leaders don’t have the luxury of spending too much time on data pilots or doing the disruptor thing. If a new approach to data or technology fails in Silicon Valley, companies may go out of business and CEOs might get a public shaming, but usually, no one gets hurt or dies. In healthcare, not so much.

What I’m getting at, I suppose, is that while the new era of data-driven care and operations is upon us, we’re at an era of both crisis and opportunity. (The noted business consultant Homer Simpson calls this “crisitunity”).

My hope is that during this transition, we learn without picking up bad habits that calcify into customs, that best practices reign, that we develop powerful new ways of helping patients. Let the creativity begin!

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Ann, I agree. Identifying high risk patients (the top 5% that will readmit or otherwise present with high cost care requirements) and closing care gaps (particularly urgent when patients are on opioids) are most urgent use cases for all of our EHR data. Problem is that other data sources must be combined with EHR data to glean true insights: pharmacy data, claims data, etc. Pop health platforms layered atop EHR seems to be the winning combination–for now.

    Thank you for sharing your thoughts and the stats. Very insightful!

  • Ann, I agree as well and Beth it’s been awhile (hope all is well)! I take a step back and view curated/cleansed data enabling Interoperability as a clear next step to accomplish not only the ability to enhance the identification of high risk patients and enabling gaps in care advancements, but also tackling AI and predictive analytics. In every industry you see leaders and laggards, but as an industry healthcare is slow to adopt and things have to change for the better sooner than later (my optimistic view)!

  • Beth and Jim, thanks for your comments and kind thoughts. We’re now entering what’s often the hardest phase of adoption, and getting through that last 5% can take 85% of the effort. Things will certainly be challenging from here on in!

  • Spot on. The Digital 20s are coming to healthcare. The critical step to succeed with all the digital transformation that will occur around care delivery and payment models is an enterprise data layer that can curate and harmonize all the data assets across the patient journey. While stronger interopability standards will help they will not be a silver bullet. Their is still some heavy data management lifting to do. Those capabilities are beyond any of the EHR vendors and they do their clients and ultimately patients no service by pretending they can be the center of a single version of truth across the organization.

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