Tuesday, August 31, 2010

How Long Will It Take to Adopt EMRs?

One story that got a lot of press last week was Prof. Aashish Jha's research update on the adoption of Electronic Medical Records. Prof. Jha has observed that only about 12% of US hospitals have a fully operational EMR at the end of 2009 and only 2% would have complied with Meaningful Use guidelines release this July that determine whether Providers can receive Federal incentives starting next year. 

Common sense suggests that electronic medical records should have much wider adoption, particularly since most sides agree that a properly implemented EMR improves patient care. After all, as one advertisement by United Healthcare recently noted, "your Pizza delivery guy stores your orders electronically. Why can't your doctor do the same?" The reality is that EMRs have not been widely adopted because there are many counter forces:
  • Medical information like health status is not as determininistic as, say, financial data. There is no unique score, or set of scores that can uniquely pin point the state of your health in a way that two reasonable, independent observers would always agree. In banking, there is no ambiguity on your bank balance when it is viewed by two separate observers. Similarly, your Pizza preferences are, in general, mostly deterministic and can be described in a way that is interpreted in the same way. I buy this argument, but it doesn't explain it all.
  • Some commentators have suggested that medicine is viewed as an art by an older generation of physicians and as long as that group makes decisions for the medical community, EMRs and other metrics-driven tools are likely to remain on the backburner. This is an artful argument, but again, it cannot explain the widespread inability of Providers to adopt EMRs. Some (more cynical?) observers have even claimed that the Providers don't want EMRs because it allows them to preserve inefficiencies and make more money.
  • The most compelling reason for the lack of adoption is simply that the benefits of EMR accure to those that don't pay for it. Put in other words, those that have to pay for EMRs aren't the ones that benefit the most. So, cash strapped hospitals are not very likely to want to make a huge IT investment if they don't see direct returns of some form. The Federal goverment has recognized this misalignment of incentives and much of the HITECH funding through Meaningful Use attempts to address this deficiency.
So, if you believe this logic, it would stand to reason that EMRs will see a much more rapid pace of adoption as Federal incentives kick in. Prof. Jha's paper seems to make a similar conclusion.
For more on the topic, Prof. Eric Ford and others published a bass diffusion analysis applied to EMRs. This study was published in 2006 and concluded that EMR adoption would take a decade longer than the 2014 target set by the Bush Administration as part of E.O. 13335 that established the ONCHIT. I have yet to see an update on this study, post Meaningful Use incentive payments, but the paper is still worth a read for its analysis of buying behavior in the medical community. Specifically, the paper examines the similarity in buysing behavior between healthcare IT and consumer goods, given that both are influenced by the coefficient of imitation (doing what key opinion leaders do) than coefficient of innovation (buying the latest and greatest). Heady stuff.

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