When President George W. Bush issued an executive order in April 2004 to establish the Office of the National Coordinator for Health IT, he had a clear vision in mind: to create a secure, nationwide interoperable network that allows authorized users to access medical records of anyone at anytime and anywhere in the U.S. President Barack Obama knew very well that his plan for providing health insurance to all Americans would not be successful unless it was paired with a plan for controlling the quality and cost of health care services.
Ironically, Bush’s health IT network was (and remains) the instrumental element that guarantees the financial sustainability of Obamacare. It was no surprise that the economic stimulus package of 2009 allocated $25.9 billion for promoting the adoption and use of electronic health records systems among American physicians and hospitals. But a decade and $30 billion later, only half of the U.S. office-based physicians have adopted a basic electronic health records system and a mere 20 percent of them use such software, according to the latest statistics by Robert Wood Johnson Foundation.
Now that the government funds for promoting adoption and use of such records are dried up, what will happen to the rest of doctors who have not ditched their old-school paper charts yet and still keep their patients’ records in a filing cabinet? In the following, I discuss three drivers which together will lead the other half of physicians to adopt electronic health records systems in the near future.
Marketing efforts by vendors
To increase their profit margins, electronic health record vendors prefer to target customers who will either make a large purchase (large health care organizations with multiple users) or are close by and thus do not require expensive marketing efforts. That is part of the reason why many of the physicians who have adopted such systems are affiliated with larger hospitals or are located in populated urban locations. Now that the low-hanging fruits are all harvested, vendors will focus their marketing efforts on small, office-based practices and will ultimately increase adoption rates.
Mergers and acquisitions in the health care sector
With the march toward value-based payment models, new forms of health care organizations will continue to emerge. Some of the individually owned physician offices will become a part of an accountable care organization or will be acquired by a larger health care organization. When these smaller practices join larger ones, they will have to adopt the technologies that are already being used by the larger organization. While electronic health records may not create substantial value for an independent practice, they will be an unavoidable necessity when small practices join larger organizations. Without them, it will be impossible for a large health care organization to coordinate patient care, manage population risks and efficiently submit insurance claims.
Data analytics tools
With a basic electronic health record, a physician can record patient demographics, medications and problems, as well as type in his clinical notes and prescriptions. (No, he cannot electronically send the prescription to the pharmacy.) A physician can also view laboratory and imaging results (only if the record system is interoperable with that of a laboratory or imaging center). That’s it; nothing more. Almost all of the defined functionalities of a basic electronic health records system could be achieved by an elaborate Excel spreadsheet. That is why many doctors are still not willing to use them, even for free. Electronic health records by themselves are just cranky databases that only archive data.
However, with the advances in artificial intelligence and decision support systems, the data that was onerously collected by frustrated doctors can now be used to create something meaningful that make doctors’ lives a little easier. The health care industry is gradually getting out of the data collection era and is now entering into the data analysis era. When doctors see tangible benefits of analytics tools such as Isabel and Watson that are based on their electronic health record data, they will flock to such systems powered by analytics tools.
Niam Yaraghi is a fellow in the Brookings Institution’s Center for Technology Innovation. This post first appeared on the Brookings Tech Talk blog.