Healthcare.gov and the other state level health exchanges are only one part of US health care reform. Another aspect of Health Care reform that is much less publicized is the Health Information Technology for Economic and Clinical Health (HITECH) Act – which is designed to build an electronic health records (EHR) infrastructure. The program is implemented using a carrot and stick approach: there are currently incentive payments made to implement EHR, but health care providers who don’t comply by 2015 will face “payment adjustments” for Medicare claims. In order to qualify for the incentive payments, the providers must not only implement EHR, but also prove that they’re getting “meaningful use” from it.
Beyond the financial incentives and hoops that providers need to jump through to attain said incentives, the advantages of using EHR will be compelling when they’re fully implemented. My doctor will no longer need to rely on my admittedly bad memory to know exactly what a specialist diagnosed after a referral. I would be able to access the full gory saga of breaking my wrist from emergency room X-ray to OT referrals, schedule whatever follow ups were needed, and know exactly what my co-pays would be. And researchers would be able to use sanitized records in big data analysis for policy planning and medical research.
We’re not there yet, and there are a lot of road blocks between now and then:
1) Doctors are not IT professionals.
And I don’t want them to be. I want them to spend their time reading the latest and greatest developments in the world of medicine. Most providers will end up hiring EHR consultants – to help in this, the Office for the National Coordinator for Heath Information Technology (ONC) website, HealthIT.gov, provides multiple spreadsheets and documents that render an excruciatingly detailed outline on how to set up a practice for EHR and how to evaluate EHR consultants. The Centers for Medicare & Medicaid Services (CMS) also provides a list of certified EHR software, with automated guides that score the software based on how well they meet CMS criteria for incentive payments. Even with this help, though, the process of implementing EHR will be a long, detailed, time consuming job for any doctor or office manager tasked with it.
2) EHR application usability is often not very good.
Health care professionals concentrate on treating patients, not on entering information about what they just did into an application. EHR applications that are not easy to use will ultimately not be used. According to the Healthcare Information and Management Systems Society (HIMSS):
- Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level.
While the ONC does not provide any guidance on EHR application usability, HIMSS has several resources that can help providers evaluate applications for usability before the applications are adopted.
3) Specialization and Interoperability
As technology and standards evolve providers may find that the EHR software they’ve implemented is not satisfactory. A lack of interoperability between departments may be a deciding factor for hospitals, while specialists sometimes find that the applications lack necessary features. Given the evolving technology and complexity of selecting software that can meet a wide spectrum of requirements, providers need to be prepared for the possibility of either migrating to a new EHR platform or re-implementing one from scratch.
Hospitals and other large providers may already have an IT infrastructure that can be scaled up to meet EHR needs, but many healthcare providers, especially small practices, will be implementing a new IT infrastructure to handle EHR. In most cases, building a new infrastructure would be the ideal environment for Cloud implementations.
There is one problem: Cloud providers need to prove they are HIPAA compliant. HIPAA has steep fines, even for violations where the “Individual did not know (and by exercising reasonable diligence would not have known) that he/she violated HIPAA”, and healthcare providers are justifiably wary of handing patient records to an offsite provider. In order to be able to use a Cloud provider for EHR, the Cloud provider must sign a HIPAA Business Associate Agreement (BAA) which ensures that EHRs will be managed securely, accessible only by approved entities, and that the provider agrees to be audited to ensure compliance. Many mainstream Cloud vendors (Amazon, Microsoft, etc.) provide BAA agreements, and some EHR vendors applications are already Cloud based.
Even with a BAA, however, healthcare providers may still be reluctant to trust HIPAA compliance in the Cloud. The Cloud may also not be the best option if there is an existing infrastructure, if the systems are critical, or if there is no stable, high-bandwidth internet connection. In these cases, virtualization can provide the necessary capacity, redundancy and security control to support an EHR system.