Accelerating EMR Adoption in America

Summary
The administration can help spur electronic medical record (EMR) adoption by promoting policies that drive development of health metrics and pay-for-performance programs, while building a health information exchange backbone, thus realizing the promise of a lower cost, higher quality American health system.

Despite its promise to transform American health care, only a minority of physicians has adopted an EMR
The US health care system is the world’s largest, accounting for 16.6% of GDP at ~$2.3 billion spend in 2008. EMRs are capable of helping our health system achieve higher quality, lower cost care. However, only ~14% of physicians have adopted EMRs, driven largely by three groups: 1) large practices realizing cost benefits 2) early technology adopters and 3) practices adopting due to employer requirements.
Current EMRs provide little economic benefit to the health system, while burdening physicians with complicated technology with little return.

EMR adoption will grow as the market evolves from a productivity tool to performance and connectivity tool
Current EMR vendors offer products that provide clinical documentation and results management. In order to become attractive to the remainder of health care providers, EMRs will need to develop two core features:
-Performance EMR: Data warehousing and mining technologies that improve care protocols through clinical decision support and reporting mechanisms to payers
-Connectivity EMR: Clinical information readily shared with all entities within health information exchange networks

The performance and connected EMR links payments to quality outcomes, reduces replication of rendered services and medical errors while easing administrative burden, thus driving down health care costs while improving quality.

The administration can help drive adoption by facilitating the evolution of EMR

Current proposals to drive adoption focus on direct subsidies to providers to assist in the purchase of EMRs. However, given current barriers to adoption, the administration should facilitate EMR evolution to make it a product necessary and desired by providers. The administration can do this by undertaking the following initiatives:

The administration should drive performance EMR through funding the development of metrics and pay-for-performance programs
- Have HHS convene public and private stakeholders in order to develop standardized outcome metrics for both the effectiveness of clinical care and the incidence of medical errors
- Provide more direct support for development of pay-for-performance programs through CMS, and work with HHS to convene private payers to understand and promote best practices in pay for performance

The administration should drive connectivity EMR through greater support of government HCIT bodies
- Increase funding for the Nationwide Health Information Network to create a set of information exchange standards and specifications
- Provide greater support for Regional Health Information Organizations to spur regional health IT architecture and tools
- Establish a formal Health IT privacy committee to ensure the protected free flow of protected, de-identified information necessary to improve health care quality while addressing privacy advocate’s concerns

By pursuing these recommendations, the administration will help the EMR market evolve, driving adoption, and in turn improve the health system’s quality while containing costs.