Wednesday, March 18, 2009

EHR Stimulus

An international debate on solutions for EHR software solutions has recently received more extensive coverage as the US economic stimulus programs focus on promotion of health information technologies in general and electronic health records (EHR) in particular. (See text versions of the American Recovery and Reinvestment Act -HR 1: TITLE XIII--HEALTH INFORMATION TECHNOLOGY )

Many important questions guide this debate, including the role of national information infrastructures and the appropriateness of proprietary vs. open source software solutions. Austin Merritt of, an online resource that helps physicians find electronic medical records, offers very salient arguments for caution in evaluating cost savings as a result of EHR adoption in the health care sector: An excerpt of the article is copied below.
With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see “The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs“), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.

Don’t get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.
Our concern is that the subsidies won’t change healthcare providers’ late adopter mindsets about information technology. Providers may jump at “free software” and try to avoid penalties (starting in 2015), but will they:

Truly believe in the value of an EHR over traditional paper charts?

Take a leadership role in advocating adoption of the new EHR in their practice?

Change their old workflows to match the best practices in leading EHRs?

Take part in intensive training to learn the new system?

Ride out the difficult stages of new software adoption and change management?

Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with “free” EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.

The issues raised in this article are of critical importance, especially those related to workflow analysis and training. EHR implementation concerns also need to be evaluated in light of the lack of an effective National Health Information Network (NHIN) with associated national or international standards for interoperability.

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