By The Numbers: EHR Adoption Barriers

Globally, health IT is a $60 billion a year sector, and a recent write-up in The Lancet, predicts that open-source solutions will be major players. Among the 114 countries that currently have national health information system initiatives, China, India and Brazil are all involved in major open-source implementations. Those are major technology players with massive populations. Domestically there are many compelling reasons why free could be the right price to stimulate nationwide EHR implementation, including the following:

The New England Journal of Medicine reports that over half of doctors now work for hospitals or health care systems. For each new doctor that’s hired, hospitals typically lose $150,000 to $250,000 per year for the first three years of employment, an example of the institution’s financial capacity to absorb large operating expenses. This speaks to their ability to afford the high costs of implementing the typical commercial EHR system as well. Hospitals and health systems are also likely to attract more attention from sales reps for whom landing one large system with thousands of doctors is much more lucrative than going door to door servicing smaller practices.

On the other side of this equation are those small private practices which account for less than half of currently practicing physicians. These include primary care providers who are especially important in rural areas or disadvantaged urban communities where distance, logistics or other barriers make travel to the “local” hospital difficult for sick folks.

Such practices are incredibly important for efforts to strengthen the nation’s primary care network, but a recent report in the Journal of the American Medical Informatics Association finds that smaller practices are also more likely to report that cost is a barrier to EHR adoption. And arguably they serve patients who could benefit most from health IT: Those who may have to travel long distances to see any of a variety of un-networked specialists. Open-sourced solutions lower the cost barrier for the physician in private practice.

Finally, a new study presented at the American Heart Association’s recent quality conference highlights the importance of EHRs linked to a patient-accessible personal health record. Yale researchers found that discretionary hospitalization for heart failure is linked to increased likelihood of re-hospitalization within 30 days, even after controlling for disease severity.

The numbers were small, but compelling: Borderline heart failure cases admitted to the hospital were about 2% more likely to end up back in the hospital within a month than similar cases that were sent home. What does this have to do with PHRs? The operative word is “discretionary”. These are situations where there’s no clear compelling reason to admit the patient, it’s essentially a toss-up and the decision to hospitalize is driven by supply, not health: For example, whether there’s a bed available. The person making such a decision should actually be the patient.

Just as EHRs play a decision-support role for clinicians, PHRs should be viewed as decision-supportive technology for patients. In cases such as discretionary hospital admission, PHRs offer a great opportunity to serve as trusted information portals for patients. For example, if you are at risk of heart failure, having access to reliable information about your condition could prepare you to engage in an informed discussion with your doctor, letting him or her know, for example, that you’d rather not be admitted unless there’s a compelling medical reason to do so, since evidence suggests it increases your risk of readmission. That’s the type of informed patient choice that has the opportunity to improve health outcomes, increase quality of life and patient empowerment, and lower health care delivery costs. And the PHR, linked to clinically updated EHR, could be the enabling technology.

Ano Lobb, MPH
Health Writer,
Instructional Designer,
Master of Health Care Delivery Science Program,
Dartmouth College