In February of 2009, the ARRA/HITECH Act allocated $19 billion for the increased adoption of healthcare IT. The idea seemed like a simple win-win: to aid the recovery of the damaged US economy, funds would be made available for making healthcare more efficient and less costly.
As of February 2013, only about 388,000 physicians, or less than half of those eligible, had received stimulus funds. So, has this program been a success or a failure? Just like the discussion around EHRs themselves, the answer is highly subjective.
The debate continues to rage — primarily from non-adopters — about the suitability of EHRs. A recent study indicates an increasing dissatisfaction with EHRs among providers. And yet, more and more articles are being written by and about adopters who point to validated statistics showing higher reimbursements, better patient satisfaction, lower costs and greater overall effectiveness.
Objectively, one must take the rational point of view that the ARRA/HITECH program has been a mixed bag. While it has started to produce some results, it is too early to declare either success or failure. There is still work to be done.
Why have billions of dollars of investment not produced better results? If you ask the two primary groups of players — the providers and the software vendors — there is plenty of "blame" going around, with each party largely blaming the other. However, if you look at the underlying causes of failures and dissatisfaction, there are actually several issues that require both parties’ commitment to solve:
1. Invest in training: When we look at situations where there is a high dissatisfaction with EHR systems, we almost always find that there was a corresponding lack of training. Software vendors usually have a pretty good idea of the amount of training required for their systems, but physicians usually object to what they perceive to be an excessive investment in terms of both time and dollars. Also, software trainers only understand their particular system and not the entire clinician work flow.
2. Redesign your work flow: In the interest of perceived savings in time and money, oftentimes both providers and software vendors implement systems without redesigning their core business and clinical processes. The thinking is, "let’s just get it up and running and then we’ll make changes later." The result is manual, labor-intensive, paper-based processes that have been in place for decades that get computerized. Providers ask software vendors to recreate their paper forms in the EHR, and many times software vendors will go along with that approach. Neither side understands that they are compromising the end goals.
3. Set proper expectations: Frequently, physicians and practice managers set budgetary decisions and implementation timelines even before the first meeting with a software vendor. They may plan out a timeline based on external dates such as remodeling their facility, expanding the practice, or schedules of annual conferences or even vacations, without taking into account all the training and implementation costs and timelines. Additionally, software vendors sometimes force transactions into an improper time slot to meet sales quotas or training windows.
4. Be committed to success: Implementation of an EHR has a big impact on healthcare providers and support staff. Oftentimes in less than satisfactory implementations, we find that the practice leadership was happy when they made the decision to implement an EHR, but they failed to fully commit to the success of the project. This means having both clinical and business office champions who are influential, committed, and able to keep the project moving forward to completion.
5. Take the long-term view: If you ask an ortho surgery patient who is still in PT if they feel better or worse than they did before the procedure, they will give you a predictably obvious answer. Similarly, many providers ask their peers if they "like" their new EHR system when they are still struggling with implementation and optimization. They are frustrated that within 2 months to 3 months there are still issues with processes and work flows, forgetting that the manual systems were developed over years or even decades. Then the myth that EHRs are "bad" gets perpetuated, and providers fall into a self-fulfilling negative view of healthcare IT systems.
Ultimately, if vendors and providers fail to fully engage each other as partners, then their EHR implementations are likely to fail. Software vendors should be willing to walk away from providers who don’t seem willing to fully partner on making the implementation successful. Providers should be willing to hold themselves accountable for the result and success of the project by doing the requisite work before, during and after implementation to ensure its success. Otherwise they should not invest in an EHR in the first place — it’s a waste of money.
The bottom line is that while ARRA/HITECH has been good for the healthcare IT industry, the work is not yet finished. If you are contemplating implementing an EHR, or are in the middle of or have completed an EHR implementation and things are not going smoothly, paying attention to the items above will vastly improve your chances of success.