After three years of incentivized industry-wide investment into EHRs as mandated by the HITECH Act, the programs and EHRs themselves are not without their detractors, challenges or cautionary tales.

Dr. Danny McCormick and some of his colleagues at Community Medicine at Cambridge Health Alliance caused a kerfuffle earlier this month when they published the findings of a study in the Health Affairs journal that showed physicians utilizing medical imaging technology ordered more test driving up medical costs, not reducing them as intended by the HITECH Act.

Authors of the study found that, based on a representative sample of over one thousand physicians, doctors who had access to previously taken computerized images were 40 to 70 percent more likely to order an additional imaging test. They theorized that the EHRs and images involved in the study enticed the ordering of these tests.

Of course this study was met with considerable resistance from those looking to keep medical costs down, especially Dr. Farzad Mostashari, the national coordinator for health information technology. In a responding blog post, Mostashari cited a 2011 study, incidentally published in Health Affairs, and wrote that “92 percent of studies on health IT were ‘positive overall’ about the prospect that technology would improve efficiency, reduce unnecessary tests, and improve the quality of care that patients receive.”

McCormick and the other authors of the more recent Health Affairs study responded with a blog post of their own. In it they answered many of Mostashari’s criticisms including one that said their study was dated as it used data collected from 2008.

“The EHR vendors that dominated the market in 2008 remain, by and large, today’s market leaders, and their products have undergone mostly modest tweaks,” wrote McCormick.

He added, “Mostashari’s contention that 2012  EHRs  – incorporating decision support and electronic information exchange – save money in ways not possible in 2008 should be tested through additional research but remains merely a hypothesis. We hope that some day his predicted savings can be achieved.”

Another recent blog post written by Dr. Jane Alder and Dr. Robert Karlsberg for healthcare consultant organization NeoVista Health warns of a “hidden barrier” to EHR adoption by private practices.

In the post, Alder warned of “(t)he vital importance of motivation and collaboration” among the providers, staff, and implementation team.  A lack of these elements in the transition process would put up what Alder called a “hidden barrier”.

“Without effective management of the human side of change the success of an EHR implementation is left largely up to chance,” wrote Alder.

The way to overcome this barrier to optimal EHR adoption is for those involved to develop psychological ownership of the project, according to Alder. She suggests the following steps to developing this psychological ownership:

•    Assess the appetite for change
•    Based on this assessment, create an urgency for change
•    Engage all staff members in planning process, including workflow changes
•    Train mid-level leaders
•    Develop a strong communication network around the transition
•    Ask for and analyze feedback regularly
•    Involve everyone in evaluating the transition throughout the entire process