From The Editor | September 16, 2010

EHR Reality Check

Vicki's NL headshots and images

By Ken Congdon, editor in chief, Health IT Outcomes

The number of hospitals that have adopted EHR systems rose slightly from 8.7% to 11.9% between 2008 and 2009. Many see this growth as an indication that EHRs are finally taking hold in the medical community. However, as we all know, EHR adoption doesn't necessarily translate to EHR meaningful use. According to a recent report by Health Affairs, only 2% of the U.S. hospitals reported as having EHRs would meet the meaningful use criteria outlined by ARRA (American Recovery and Reinvestment Act) incentives. The report, titled A Progress Report on Electronic Health Records in U.S. Hospitals, analyzed data from an American Hospital Association survey that polled 3,101 non-federal acute-care hospitals about their health IT capabilities as of March 1, 2009. In my opinion, the results of this report are skewed for one obvious reason — meaningful use criteria weren't defined until mid-2009 and the final Stage 1 meaningful use rulings were just released a month-and-a-half ago. Clearly, hospitals that adopted EHRs prior to March 1, 2009 had no idea how the federal government would define meaningful use and weren't implementing these systems with this criteria in mind. One would hope that the 2% figure indicated by the report would improve if you surveyed hospitals about their health IT capabilities today. Hospitals are now motivated to hit specific EHR benchmarks outlined by the federal government and are installing new systems or updating existing ones in line with this criteria.

EHRs Result In Longer Wait Times? Another recent study (based on old data) published in the journal Medical Care Research and Review also calls the effectiveness of EHRs into question. This study, which analyzes results from a 2006 Arizona State University survey of 30,000 patient visits to 364 U.S. hospitals, shows that use of basic EHR systems that aren't "fully-functional" result in longer wait times in hospital emergency departments (EDs).

According to the results, patients who received care at an ED with a basic EHR system experienced 47% longer wait times than those visiting EDs with minimal or no EHR systems. However, the researchers also found that patients who sought care at hospital EDs that had a fully functional EHR system experienced a 22% shorter length of stay and 13% shorter treatment times than patients who visited EDs that had minimal or no EHR systems.

Among the facilities included in the study:

  • Only 1.7% of EDs surveyed had fully functional EHR systems;
  • 10.8% of EDs had basic EHR systems; and
  • Nearly 88% of EDs had minimal or no EHR systems.

EHRs Effective If Implemented Correctly
While each of these studies is slightly flawed in my opinion, they do point out one universal truth — EHRs will only be effective at streamlining healthcare workflows if implemented correctly. You'll notice that in the previous study that fully-functional EHRs contributed to significant reductions in wait times and treatment times. Simply plugging in the software and hoping for the best is a recipe, however, for disaster. Healthcare facilities need to fully understand their existing workflows and how these workflows can be optimized through digitization before implementing EHR technology. Also, rather than rushing into an EHR implementation in an effort to capitalize on federal stimulus incentives, many facilities may be better served by easing into EHR adoption by first installing smaller automation systems, such as document imaging and capture systems, e-forms solutions, or e-prescribing platforms. These systems can provide the "baby steps" some facilities need to become comfortable with the technology itself and the workflow changes these systems trigger.

Secondly, it is important to become familiar with the federal government's meaningful use criteria, deadlines, and incentive payout schedule. You'll want to capitalize on the incentives that make sense for your facility and are in line with your EHR rollout plan. However, don't base your plan solely on securing meaningful use incentive payments. Much of the federal government's meaningful use criteria is to progress the U.S. healthcare system toward an automated and interoperable environment at the fastest pace possible. You'll have to judge whether or not this pace is realistic for your healthcare facility. Remember, rushing an EHR project can lead to an ineffective implementation. And, as illustrated by the aforementioned studies, and ineffective EHR implementation can produce negative results instead of the positive productivity, financial, and patient satisfaction gains that are intended.

Finally, it's important not to lose sight of your patients on your quest for EHR meaningful use. Digitization is designed to improve their quality of care. Healthcare facilities need to take the steps necessary to ensure this occurs. A guest column by Ann B. Scales of Standard Register titled Don't Overlook Patients On The Road To Meaningful Use provides more on this topic in this week's email newsletter. I encourage you to read it.

Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at