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The Conundrum of Physician Adoption of HIT, Health Information Exchanges (HIEs) and Stimulus Funding

Despite an increasing amount of literature and anecdotal evidence that electronic medical records (EMRs) improve quality of care, many clinicians harbor lingering doubts about the value they will gain by implementing an ambulatory EMR in their office.  The concern is not without merit.  EMRs today do provide value to the physician by providing real-time access to legible patient data, clinical decision support tools and reporting capabilities; with attentiveness to work flow redesign during implementation this value can be gained without unacceptable impact on physician time.  However, it is dissappointing to physicians that there is a significant gap between the value EMRs bring today and the largely untapped potential value of connecting EMRs in order to confidentially share patient data across the community.  Current EMR technology makes possible physician access to critical patient data in disparate EMRs entered by other community providers, hospitals, labs, radiology departments, emergency rooms and other credible sources. The technology infrastructure that allows this exchange of patient data between EMRs is called a health information exchange (HIE).  The value of ambulatory EMRs increases significantly when connected to an HIE infrastructure that enables access to and display of exchanged community-wide patient data whenever, wherever the physician needs it for patient care.   

This additional value of ambulatory EMRs cannot be fully realized until a critical mass of providers in a community are using EMRs and the community has the HIE infrastructure available to connect EMRs. For example, if 99% of medical records are paper and only 1% are entered electronically across a community, the value to a physician for connecting with the HIE would be minimal.  The conundrum is that the business model to allow HIEs to thrive is also dependent on a critical mass of providers using EMRs because EMRs provide the HIE with its commodity which is patient data.  HIEs in communities with low EMR usage therefore have difficulty sustaining their existence for financial reasons.  

HIE infrastructure is growing but is still not prevalent in our communities; also, less than 10% of U.S. physicians are using a fully functional EMR according to the New England Journal of Medicine (NEJM, Volume 359:50-60, July 3, 2008, No. 1).This conundrum is addressed by the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) portion of the federal economic stimulus program.  HITECH provides not only incentive payments to physicians who adopt EMRs, but also funding opportunities for the development of HIE infrastructure, policies/regulations for privacy/security and "Regional Centers" to help coordinate this effort.  The purpose is to not only stimulate enough momentum for physician adoption of EMRs to reach a critical mass, but also to concurrently stimulate the development of more robust community HIE infrastructure.  The conundrum requires a concurrent effort so that, as doctors adopt EMRs, new HIE infrastructure adds value by enabling physicians to access a comprehensive set of patient data from the community in a practical, useful and confidential manner.  

drmattmurray

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