Nearly a decade after research firms predicted major cost savings and clinical benefits from the use of health-IT, adoption rates among U.S. medical providers remain sluggish, with the industry slow to embrace the big-data movement.
Electronic health record (EHR) adoption has been fastest at larger, more technology-savvy medical organizations, while smaller practitioners -- which make up the bulk of U.S. clinicians -- have been slow on the health-IT uptake for a variety of reasons, chief among them the cost, but also the training time and effort needed to make the move from paper. Those that don't adopt EHRs by 2015 face decreased government reimbursements for Medicare patients under existing law.
Questions surrounding the effectiveness and financial impact of EHRs were raised in a January report from RAND Corp., which reconsidered its 2005 prediction that health-IT, including EHRs, could save the U.S. approximately US$81 billion annually. The new report on the technology noted that health costs have increased since the 2005 research and called the clinical benefits "mixed."
But there are EHR success stories such as Kaiser Permanente and the Cleveland Clinic, and some health-care providers are rapidly embracing the benefits that big-data analytics brings to clinical medicine.
"The government is pushing [EHR use] along and it's becoming a standard of care," said Tom Handler, research director of Gartner's health-care provider analyst group and a former physician. "At some point in the near future, not heading down the path of an EHR [system] will not serve an organization well."
Long-term use of health-IT can lead to reduced care costs, even if expenses initially increase, he said.
In addition to the cost of the EHR system itself, its use could also increase medical costs by reminding doctors to order required tests that they forgot, he said. But this detailed care should lead to healthier patients who need less expensive medical treatments overall. For instance, an EHR system that reminds a doctor to contact a diabetic patient to schedule an appointment could lead to lower long-term care costs if the software ultimately helps to prevent the need for the patient to have a foot amputated, he said.
The U.S. government is nudging providers to adopt health-IT and is picking up some of the tab for EHR deployments. Costs for a system vary widely, from tens of thousands of dollars for a small practice to upwards of $1 billion for a major system implementation.
As part of the American Recovery and Reinvestment Act, the government dedicated $20.6 billion to EHR projects. Providers must show that EHR use improved health care through a series of reimbursement guidelines called meaningful use. The first phase dealt with purchasing and rolling out EHR systems and began in 2011. The second phase includes data interoperability provisions and started this year. Phase three covers improving outcomes and starts in 2015.
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