Sunday, June 3, 2012

EHR Cont'd: Challenges to Adoption

Given the benefits reviewed in my last post on EHR, why haven't hospitals and clinics jumped at the chance to adopt EHR? In fact, the US lags behind other countries in the adoption of EHR and as of 2008, according to one HIMSS study, only 44% of hospitals had fully functional EMR systems, and only 4% of US physicians had access to a EHR system. Although with the incentives on offer with the HITECH Act and the possible penalties for failing to adopt to EHR, this scenario is shifting and we're starting to see a critical mass develop towards adoption. According to a recent study conducted by IDC concludes "meaningful-use" adoption can reach as high as 80% by 2016.

Hospitals and clinics report a number of barriers to adoption. These include costs, interoperability issues, conversion of historical documents, training and usage, and privacy/security concerns. These issues are often interrelated and identifying to solutions for that will be key to the successful implementation of EHR systems.

Costs: Many providers are unable to accept the financial burdens of adopting EHR. To successfully implement a EHR system the hospital will have to bear hardware costs (servers, scanners, etc.), software costs (billing applications, clinical applications, drug databases, etc.) and other interface application costs (lab interfaces, medical device data, etc.). By some estimation it costs between $40,000 to $70,000 for a single doctor and his patients' records to be successfully migrated to EHR.

Interoperability issues: When implementing EHR system hospitals need to worry about multiple applications being able to interact with each other and share data. For instance, data from lab applications may not integrate well with data from billing systems. Again, projects to support interoperability will hike up implementation costs.

Training staff to use the new EHR system is a major concern, as EHR systems will be a completely new way of doing care plans or charting.

And lastly hospitals worry about the protection of their patients data. A breach could occur with the paper filing system as well, but can be restricted to limited say to one filing cabinet. (How many medical records can a thief run away with?). However with a breach in EHR databases can comprise the information of an entire department or hospital.

These concerns while valid are not insurmountable.... In my next post, I will look at some of the solutions available to hospitals that address these concerns.

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