In 2009, President Obama signed into law the Health Information Technology for Economic and Clinical Health Act (HITECH Act) as part of an economic stimulus package. HITECH’s primary goal was to increase the number of healthcare providers using electronic health records (EHR) as opposed to paper ones. Starting in 2011, healthcare providers that could prove “meaningful use” of EHR software would receive substantial government subsidies . In 2015, the economic incentive would flip to an economic penalty and providers not using EHR’s would lose out on a percentage of government Medicare and Medicaid reimbursement . Although the deadline was subsequently pushed back due to slower progress than expected, the legislation has been successful in catalyzing a trend towards the digitalization of healthcare. EHR adoption is clearly the way of the future and is no longer a question of if but when.
Partners Healthcare, a large Boston-based hospital system, is in the midst of its multi-year and $1.2 billion EHR implementation . According to Keith Jennings, the Chief Information Officer at one of Partners’ affiliate hospitals, “a project like this, this is not an IT implementation, this is a business transformation for your clinical systems, your clinical user” . The business model transformation Jennings mentions has to do with how EHR’s change the entire healthcare delivery system.
EHR’s improve healthcare quality by increasing coordination across all of the settings that a particular patient receives care. Regardless of specialty or physical location, any doctor can immediately access a patient’s medical history. This information gives the doctor tremendous insight into the patient’s comorbidities, allergies, medications, and past treatments, which all factor into the doctor’s subsequent treatment plan. The software surrounding the EHR can also provide recommendations based on clinical guidelines and best practices for particular indications . In addition to improved efficacy, EHR’s have the ability to save healthcare providers money through the elimination of duplicative tests, paper storage, etc. .
Despite its benefits, implementing an EHR system does not come without friction. The move from paper to electronic records has required a transformation in the way hospitals operate. Some healthcare providers find electronic data entry to be more efficient than paper methods, but others are overwhelmed by it. The Boston Globe cited sources who thought that the EHR brought an “insatiable demand for information that, keystroke by keystroke, click by click, overwhelms the already tightly wrapped day inside a hospital, eats away at time with patients, and sometimes forces them to work longer shifts” [7, 8]. It will likely take time and continuous training for Partners to unlock the bulk of the efficiencies offered by EHR. In order to ensure a smooth transition, Partners has hired hundreds of IT workers to prepare and optimize the software. It has also staggered the implementation in phases, so that learnings from one hospital can be incorporated into the next hospital’s implementation .
EHR implementation is just the tip of the iceberg for how information technology can revolutionize the practice of healthcare. As the number of electronic health records grows and time passes, the longitudinal health data they contain will be extremely valuable. It will allow for the comparison of treatment efficacy across patient types to help inform best practices and can also be used for predictive analytics . Healthcare providers can use this data themselves or potentially monetize it through selling the data to pharma companies or software vendors. Despite all the current and future benefits, Partners Healthcare needs to be vigilant about the risks. EHR’s contain extremely sensitive health information, which means Partners must make sure it has a state of the art cyber security system that is continuously upgraded. Only time will tell the true costs and benefits associated with EHR implementation. (619 words)
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