Richard Jacoby, MD
Jefferson School of Population Health
A key factor contributing to high cost and poor quality of health care in the United States is the lack of computerization in health care, and specifically the low adoption rate of electronic medical records (EMRs). In the world of quality, the fundamental elements are the triad of structure (personnel and equipment), process (the things that you do), and outcome (the results you achieve). Having adequate structure (EMRs in this context), is a necessary but not sufficient building block to achieve optimal outcomes.
Computerization is acknowledged to be the single largest factor contributing to increased productivity in the civilized world. EMRs, a technology that has the ability to break down the current silos of information and poor communication that exist among providers are used by less than 20% of physicians in the United States. Cost, interruption of workflow, and lack of adequate technical support are cited as the main barriers to adopting EMRs.. In other parts of our economy, the marketplace has fueled the drive toward computerization. Given the failure of the marketplace to drive health care in that direction, the U.S. Government through the Department of Health and Human Services (DHHS) has stepped in to try to accelerate the adoption of EMRs.
The American Recovery and Reinvestment Act of 2009 (the “stimulus bill”) contained within it the Health Information Technology for Economic and Clinical Health (HITECH) Act. This program allocated $19 billion to subsidize the purchase and “meaningful use” of EMRs by physicians and other providers in the United States. In the criteria for achieving the subsidy, the government laid a roadmap by which health care providers will not simply adopt EMRs, but use them to achieve health and efficiency. The DHHS defined “meaningful use” carefully so as to further five specific, comprehensive, and unifying health care goals: improving the quality, safety, and efficiency of care while reducing disparities; engaging patients and families in their care; promoting public and population health; improving care coordination; and promoting the privacy and security of EMRs.
Providers engaged in ambulatory care can generally earn up to $44,000 in extra payments if they become meaningful users of EMRs (more if they are eligible for the Medicaid program). Hospitals that succeed in achieving “meaningful use” are eligible for payments in the millions of dollars.The intent of these payments is to offset the cost of the purchase of the EMRs. Additional funds have been made available to establish centers that will provide consultants to support providers in the selection, adoption and use of EMRs. If getting providers to do the “right things” in our current healthcare environment is a matter of proper planning and aligning incentives, the HITECH Act is surely a step in that direction.