In the last ten years there have been significant efforts made toward building a healthcare information technology (IT) infrastructure in the United States that allows for secure and reliable exchange of patient information between healthcare providers, medical professionals, and individual patients. The success of these systems has tremendous implications for the overall health and wellbeing of the entire population. While individual patients are the centerpiece of these efforts, effective electronic health record (EHR) interoperability would also impact healthcare policy by providing population-level data for national decision making. Despite the benefits associated with health IT interoperability, numerous barriers still stand in the way of its successful implementation. The complexity of standardization and unintended finance and security-related consequences are challenges that remain to be addressed.
In 2009, President Obama signed the American Recovery and Reinvestment Act, which sought to improve the national health care delivery system by digitizing all patient records. The Health Information Technology for Economic and Clinical Health (HITECH) Act was a part of this initiative that invested $35 billion to incentivize the adoption of EHRs by hospitals and providers, and to achieve interoperability through all levels of the health system. HITECH evaluates “Meaningful Use” of EHR information via: 1. Data Capture and Sharing, 2. Advance Clinical Processes, and 3. Improved Outcomes. Though HITECH appears to have increased utilization of EHRs, with 96% of hospitals and 80% of office-based physicians in the US having adopted a certified EHR program, their overall effectiveness is less certain. Only 12% of physicians were able to meet stage 2 of the meaningful use criteria and 6% were able to share patient data with other EHR systems in 2015.1 In a survey of 5,000 anesthesiologists, 49% reported unanticipated need for ongoing IT support and 61% reported difficulty integrating Anesthesia Information Management Systems (AIMS) with an existing EMR as major problems.2
Experts examining the health IT ecosystem identify challenges that include lack of cooperation among stakeholders, regulations, and misplaced focus on incentivizing EHR adoption without considering HIE. In fact, the Office of the National Coordinator for Health and Information Technology (ONC) found evidence of information blocking between EHR and HIE leaders, which led to the passing of bipartisan legislation instituting penalties of up to $1 million to tech developers, networks,
and providers who participate in information blocking.1, 3
Increased adoption of EHR can place additional strain on physicians in their daily practices. Researchers found that physicians spent two hours on clerical or EHR-related duties for every hour of clinical work.1, 4 Federal certification demands as well as documentation requirements for demonstrating “meaningful use” of EHR systems can unintentionally penalize physicians for technology failures. Eligible practices that fail to implement EHR or demonstrate its meaningful use could be penalized between 1-5% of Medicare Part B reimbursements each year. In 2017, over 170,000 providers faced such penalties.1, 5 Disproportionate burdens placed on smaller practices include the high yearly EHR implementation costs that range from $15,000-$70,000. Many have opted out of the program, choosing to lose Medicare reimbursements rather than comply.1, 6 Despite these caveats, some argue that EHR systems could save smaller anesthesiology practices by helping them stay relevant as procedures require more data-backed justification by insurance companies for MACRA and MIPS reporting.7
Since the passing of HITECH, the ONC has outlined a 10-year vision for achieving an interoperable health IT infrastructure by 2024. Their guiding principles include customizability, ease of patient access, cost effectiveness, privacy, and security.8 They plan to achieve their goal by establishing core technical standards and utilizing the ONC Health IT Certification Program to test products and services. The document also describes continued monitoring of digital health information exchange systems to identify and address weaknesses in security as well as building a more supportive business, clinical, cultural, and regulatory environment by incentivizing ONC-certified health IT products.
Anesthesia providers may already have encountered the challenges and benefits associated with EHR adoption and compliance in their own practice. Moving forward, it will be important to continue weighing the short and long term costs and benefits associated with investing in EHR interoperability. Providers should consider what is necessary to meet their bottom-line while also contributing to a larger national vision for improved patient care through information access and exchange.
- Reisman M. (2017). EHRs: The Challenge of Making Electronic Data Usable and Interoperable. P & T: a peer-reviewed journal for formulary management, 42(9), 572–575.
- Trentman, T.L., Mueller, J.T., Ruskin, K.J. et al. J Clin Monit Comput (2011) 25: 129. https://doi.org/10.1007/s10877-011-9289-x
- Upton F. H.R.6—21st Century Cures Act. 114th Congress (2015–2016); July 13, 2015; [Accessed June 4, 2017]. Available at: www.congress.gov/bill/114th-congress/house-bill/6?r=9.
- Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in four specialties. Ann Intern Med. 2016; 165(11):753–760.
- Centers for Medicare and Medicaid Services. Medicare electronic health record (EHR) incentive program payment adjustment fact sheet for eligible professionals. [Accessed June 25, 2017]. p. 2017. Available at: www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_EPTipsheet.pdf.
- Creswell J. Doctors find barriers to sharing digital medical records. The New York Times. Sep 30, 2014. [Accessed June 30, 2017]. Available at: www.nytimes.com/2014/10/01/business/digital-medical-records-become-common-but-sharing-remains-challenging.html.
- Health IT News. (2017). Anesthesiologists find EHRs free up face-time for patients. Retrieved from https://www.healthcareitnews.com/news/anesthesiologists-find-ehrs-free-face-time-patients.
- The Office of the National Coordinator for Health Information Technology (ONC). (April 30, 2018). Interoperability. Retrieved from https://www.healthit.gov/topic/interoperability