Declaring the era of clinician resistance to IT "behind us," John Glaser, who is leaving his job as CIO of Partners HealthCare System in Boston to become CEO of Siemens Healthcare's Health Services unit, spells out four barriers to EMR acceptance and four steps being taken to overcome those problems.
Writing in InformationWeek, Glaser notes that healthcare is highly fragmented, with many small organizations that lack the time, staff and cash to invest in IT. The prevailing fee-for-service reimbursement model also hinders IT adoption because providers don't see much financial incentive to adopt EMRs. Health information exchanges haven't flourished, due to the lack of financial incentives, but also because the industry hasn't agreed on all the necessary data-exchange standards. Plus, the explosion of medical literature leads to constantly changing standards of care, but, Glaser says, "for the vast majority of the 10,000 diseases, syndromes, and problems that exist, care tends toward trial and error."
Glaser, who recently spent a year as a special advisor to national health IT coordinator Dr. David Blumenthal, sees four paths to change: payment reform, provider support, product improvement and better safeguards for privacy and security. In most cases, healthcare has begun to make progress on all fronts.
Clearly, the "meaningful use" EMR incentive program represents payment reform, while the Patient Protection and Affordable Care Act offers up more signs that Medicare and Medicaid are in transition to quality-based reimbursement. "The result will be a snowball effect," Glaser writes. "Private sector payers likely will follow the government's lead on payment reform, and groups that manage physician board certification and licensing now are considering making EHR use part of their requirements."
The $1.2 billion in stimulus funding for regional extension centers and for state-level health information exchange will help support provider adoption of EMRs, while proposed new HIPAA regulations are meant to reassure providers and the public about privacy and security of electronic health information.
On the product front, the migration to cloud computing and pay-per-use models is making EMR technology and IT management more affordable for even solo practitioners and the smallest community hospitals, but there is more room for improvement. "No physician wants to scroll through a list of 10,000 possible problems when working in an EHR. Products must be designed to 'think like a doctor,'" notes Glaser.
- read Glaser's commentary in InformationWeek