A September report from the Government Accountability Office (GAO) found that while progress is being made in terms of electronic health records (EHR) interoperability, healthcare providers in the United States are still far away from full implementation. Interoperability is the idea that different EHR systems would be able to pass information to each other. The study primarily looked at 18 initiatives currently being engaged in by nonfederal stakeholders, although the study recognized the necessity of the federal government in EHR implementation. In examining these programs, GAO found five challenges: “(1) insufficiencies in health data standards, (2) variation in state privacy rules, (3) accurately matching patients’ health records, (4) costs associated with interoperability, and (5) the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.” The study also found that a key to moving EHR interoperability forward will be the recognition by health care providers that it is a valuable tool for improving clinical care.
EHR implementation was mandated in 2009 by the Centers for Medicare and Medicaid Services (CMS) and the Office of National Coordinator for Health IT. The initiative CMS began, known as “meaningful use,” was a three-phase-in-five-years program started in 2011 to encourage healthcare providers to begin using EHR. The first stage focused on getting Medicare eligible healthcare providers to eliminate manila folders and replace them with standardized, electronic formats, which patients would have access to through an online portal. In the second stage, Medicare eligible providers needed to meet a quota of 5% of patients being on EHR if that health care provider wished to qualify for the EHR Incentives Program (which is managed by CMS). In 2014, when the second phase was supposed to end, 48% of Medicare eligible professionals and 65% of Medicare eligible hospitals met the phase 2 quota. Due to the low numbers, the 5% quota has been extended until 2017, and in 2018 the quota will rise to 10%.
Additionally, there have been issues getting doctors and patients to accept EHR. Patients who are relatively healthy are not all that interested in monitoring their health, and the programs are not overly consumer friendly for patients and doctors alike – often containing long drop down menus and producing documents up to 70 pages long. These issues are also impacting daily life for doctors. In general, it takes much longer to input data into the system than it would a normal written record. Doctors also worry that having their patients input their information into computer systems, rather than through discussions with doctors, could weaken interpersonal relationships between doctors and their patients.
Even in places where EHR implementation appears to be succeeding, like Massachusetts (which boasts over 80% acceptance among physician practices), other issues such as a multitude of EHR programs being available – and thus no standardization across healthcare providers – causes frustrations. One healthcare provider noted a setup cost of $84,000 for their EHR system and related IT systems. Some improvements are happening naturally. In Massachusetts for example, 80% of healthcare providers are using one of seven EHR programs whereas before, there were as many as twenty. Hopefully as the GAO report suggests, as the meaningful use program moves into the third phase in the coming years, interoperability becomes more of a focus.