The United States lags far behind global leaders in using Electronic Medical Record (EMR) systems, according to a recent report by The Information Technology & Innovation Foundation (ITIF). ITIF recommends that the U.S. should borrow policies from leading nations to help spur EMR adoption. Until the advent of the HITECH stimulus package, the U.S. government has largely taken a free market approach to EMR adoption, which can explain much of the implementation gap. Despite lagging EMR adoption rates, the U.S. government should be careful not to force physicians to adopt a system that may not help them in the long run.
According to the ITIF report, the U.S. lags Denmark, Sweden, and Finland in EMR implementations. Unlike the U.S., the governments of these countries played a much more active role in promoting EMR adoption. Denmark and Finland began promoting EMR use as far back as 1994. Denmark also mandated e-prescribing, and 100% of primary care physicians send electronic prescriptions as a result. Likewise, Denmark requires physicians to issue electronic patient referrals and keep clinical records in a standard format.
In terms of adoption rates, 100% of primary care physicians use EMR in Sweden. 99% use EMR in Finland, and 95% in Denmark. The U.S. offers a stark contrast, where only 28% of primary care physicians use EMR, according to the ITIF report. However, this percentage should rise in the near future as the HITECH Act gets underway.
The HITECH Act is part of the so called “stimulus package,” and offers up to $44,000 for qualified physicians who implement a certified system and comply with the meaningful use requirements. The $44,000 is paid through Medicare reimbursements and can only be collected once physicians have purchased, implemented, and started using an EMR system in their practice.
The U.S. government has traditionally taken a more laissez-faire approach to EMR and health information technology up until the passage of the HITECH act, at least compared with its European counterparts. Although stronger government mandates and directives may have worked in Scandinavia, the U.S. government should be careful not to become too aggressive in promoting EMR. There is always a danger that physicians will purchase an EMR system under government pressure that may not work for them in the long run.
EMR implementation horror stories are well known among American doctors, and are a significant cause of low adoption rates. While EMR systems can provide many benefits to a practice, such as decreasing cost, increasing revenue, and improving patient care, physicians should choose their systems wisely. Purchasing the wrong system can have lasting negative consequences. Physicians should purchase the simplest system that will meet their needs. Simple EMR systems are best; they are easy to learn, use, and implement. Simple EMR systems can adapt as your practice changes, so you won’t be stuck with something that no longer fits your needs.
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Ryan Ricks
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6 Comments
Mary - Oct 1, 2009
I understand that the adoption rate is much higher in other countries, and I agree that it is definitely because the government in those countries were proactive in EMR adoption.
I have two questions:
1. Do you know the number of EMR vendors that are available to other countries? I know that in the US there are over 300 vendors which is extremely overwhelming.
2. With the government in other countries being proactive, do you believe that physicians had successful EMR implementations initially? Or do you believe that many had unsuccessful implementations before finding the best EMR for their practice?
Ryan Ricks - Oct 1, 2009
I’m not really sure how many EMR vendors sell overseas.
I haven’t seen any data regarding foreign implementation success. If the government mandates EMR, then physicians have to purchase a system and use it whether they like it or not. They may have to go through a difficult transition phase to change their process to fit the EMR system. Many times implementing an EMR requires drastic changes in a practice.
In the U.S., we are not yet mandated to use EMR. If a practice buys a system that ends up not working, then they are free to get rid of it. Many implementations fail because of either insufficient training, lack of user acceptance, or the practice can not or won’t change their workflows to match the software.
Jim Taylor - Oct 7, 2009
Ryan,
Great points on implementation failures. Many practices are missing the fact that you need to work with the right technology people to get the best implementation experience. The EMR guys will either sell you the software or the software and equipment. The stuff will play nice on it’s own but how is it going to interact with the pre existing infrastructure? All practice technologies need to be on the same page and managed on an ongoing basis as such.
midwest practitioner - Oct 30, 2009
Part of the problem with the HITECH stimulus package is the lack of upfront money to help pay for the implementation of the product. I agree with purchasing the simplest system, but there is no guarantee that it will “talk” to the other systems. Which then makes sharing the EMR a real problem.
Nelson Best - Oct 31, 2009
What kind of stimulus package is available for cash only medical facilities? We don’t accept Medicare payment.
Njbest
Dunellen NJ
Dr. Pedram Aslmand MD - Oct 31, 2009
Does anyone have some good resources on helping to get the Stimulus Package paperwork done in California?