The federal government is happy to point out that more than 50 percent of physicians and 80 percent of hospitals are using electronic health record (EHR) systems, with those users having received some $14.6 billion in meaningful use incentives initially allocated in the 2009 stimulus.
But there's more to meaningful use than EHR adoption numbers. A number of studies suggest that healthcare providers are increasingly dissatisfied with the EHR systems they have, with nearly 40 percent saying they wouldn't recommend their EHR to a colleague and more than 30 percent saying they are buying a new EHR system to replace existing software.
Its a telling fact that the number has risen since 2010, when meaningful use was first defined, and has risen as EHR use as correspondingly gone up. The Annals of Internal Medicine suggests in a recent editorial that meaningful use had the unfortunate, unintended consequence of spreading the use of EHR systems that don't work well.
The bigger issue, though, is the EHR systems themselves.
EHR Use at a 'Tipping Point'
The recent Accenture Doctors Survey suggests that global EHR use has reached a tipping point, with 60 percent of physicians using EHR systems in a clinical setting and 91 percent doing so in a clinical or hospital setting.
Upticks in adoption are largely the result of public policy initiatives in the United States, Singapore, Canada and elsewhere, says Kaveh Safavi, Accenture's health industry lead for North America. The key in the U.S., as the HITECH Act of 2009 illustrates, was recognizing that the public sector needed to nudge the private sector into technology adoption. This is largely because the benefits of EHR use are realized by numerous stakeholders, ranging from patients and government agencies to insurers and healthcare organizations, while the costs are borne largely by physicians, he says.
According to Accenture, physicians are more likely than ever to characterize their EHR use as "routine." Two-thirds of those surveyed enter notes during or after a patient encounter, nearly half access clinical data about patients seen by different health organizations, and more than one-third receive alerts or reminders during an encounter.
"I don't think there's anyone who thinks this is a fad," Safavi says.
Many Doctors Don't Like the EHR Systems They Have
The picture isn't entirely rosy, though. According to HIMSS Analytics, the data and market intelligence arm of the Health Information and Management Systems Society, half of the nation's more than 18,000 ambulatory hospitals and clinics remain paper-chart based.
Those that have gone digital aren't always happy. According to a December 2012 HIMSS Analytics survey, 35 percent of those institutions plan to purchase, replace or upgrade the EHR system they do have. A spring 2013 Software Advice survey had similar findings. More than 30 percent of providers aim to replace their EHR system, the research firm says; of those who are replacing, more than 60 percent say the main reason is dissatisfaction with the system they have, with top reasons including a lack of key features, a cumbersome and complex interface, poor EHR usability and bad hardware.
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