February 22, 2006
Electronic health records (EHRs) have the potential to address two of the most critical challenges facing the U.S. healthcare system: enhancing quality of care and controlling costs. But HFMA research shows that hospitals face a number of barriers in acquiring and implementing EHR systems -- the most pressing of which are lack of standards, funding, interoperability, and physician usage.
In December 2005, HFMA surveyed healthcare finance executives to identify the challenges that hospitals face in EHR adoption as well as the steps that government could take to encourage adoption. The survey was amplified by two roundtable discussions with senior financial executives that were conducted by HFMA in collaboration with David Brailer, MD, PhD, National Health Information Coordinator for the U.S. Department of Health and Human Services and the person who is spearheading the Bush administration's drive toward national EHR adoption.
EHR Implementation Barriers
The results showed that, although healthcare organizations have come a long way in regard to EHR adoption, they still have a long way to go. Of the 176 healthcare finance executives who participated in the survey, 62 percent responded that a lack of national information standards and code sets is one of the most significant barriers to EHR adoption. Fifty-nine percent reported that a lack of available funding is a significant barrier; 51 percent, concern about physician usage; and 50 percent, a lack of interoperability.
Only 28 percent of senior finance executives who were surveyed cited insufficient financial return as a significant barrier, suggesting a faith in the promise of EHRs and a determination to implement these systems that transcends traditional financial thresholds. Funding and return on investment were higher concerns for hospitals indicating a low level of EHR adoption than for those indicating a higher level. Mid-sized hospitals were more concerned about funding as a barrier than either large or small hospitals, and funding was a more significant barrier for rural hospitals represented in the survey.
"How are we ever going to get there from here?" Brailer asked during the roundtable discussions. "It's a feat of culture, professionalism, and finance more than it is anything about technology."
The Government's Role in Advancing EHRs
Survey findings also indicate that hospitals believe government action in the areas of standard setting and financial support would significantly speed adoption. The highest expectation that hospitals have for government is to facilitate the creation of standards and code sets, with 57 percent of respondents citing this as an "extreme" expectation and 22 percent citing this as a "high" expectation. Respondents also hope the government will require private payers to adhere to any national IT standards that are developed. But healthcare executives also are wary of federal intervention in standards setting, especially after HIPAA has caused so many compliance problems.
Progress Being Made
The EHR functions in which the greatest proportion of hospitals reported significant progress were order entry (37 percent significant progress), results management (27 percent), electronic health information/data capture (23 percent), and administrative processes (23 percent). The smallest proportion of hospitals reported significant progress in clinical decision support (13 percent), health outcomes reporting (13 percent), and patient access (2 percent). Larger hospitals were comparatively further along in EHR adoption than mid-sized or small hospitals, and nonrural hospitals were slightly further along than rural hospitals.
The promises of EHRs are many: fewer adverse drug events, lower morbidity and mortality rates, seamless continuity of care, greater efficiencies, and lower costs. "HFMA believes that universal implementation of electronic health records will produce a profound societal return, both in improving the quality of healthcare in our country and in reducing healthcare costs," said Richard L. Clarke, DHA, FHFMA, President and CEO of HFMA. "HFMA also believes that the true societal benefits of EHRs occur only through universal adoption."
SOURCE : Overcoming Barriers to Electronic Health Record Adoption; Results of Survey and Roundtable Discussions conducted by the Healthcare Financial Management Association
Additional Information
- EHR Investments: The Value Case for Senior Healthcare Financial Executives
- Financing the Future web site
- Healthcare IT: Getting Value from the Investment, an hfm magazine collection
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble at lnoble@hfma.org.
HFMA Wants You to Know ISSN: 1540-0697. Volume V, Issue 4. Copyright 2006, Healthcare Financial Management Association. All rights reserved.