Electronic Health Records: What’s Taking So Long?

The path to wide-scale EHR implementation is still barred by many obstacles.A decade ago, most medical practice managers believed that the shift toward the total digitization of medical information was inevitable. In reality, however, the transition from dead trees to bytes has proven to be a bit more complex than expected.

InformationWeek’s recent take on the slow march toward universal EHR implementation insightfully points out some of the chief obstacles that have hindered and delayed the transition process.

Basically, EHRs are digital files that contain an individual’s personal medical information. The term EMR (electronic medical record) usually refers to a single file containing one type of medical data within a software program, while EHRs are often broader in scope, encompassing both medical records and related data such as insurance information that can be shared between different healthcare providers.

If you find the nomenclature a bit confusing, you’re not alone—in fact, the continuing debate about differences in the terminology used in various EHR systems is one of the chief obstacles that has held back universal implementation of digital health records.

Today, it is estimated that less than 10% of all medical practices use EMR systems—and most of those are thought to be hospitals and other larger institutions. Both the insurance industry and the federal government strongly favor the creation of central repositories of EHRs that can easily be shared among medical providers. Supporters of this approach contend that widespread EHR use will increase efficiency, improve the ease and accuracy of statistical analysis, reduce the adverse effects of inaccurate, out-of-date, or missing health information, and ultimately, help fulfill the promise of better and more cost-effective healthcare.

However, it may be decades before these predictions come to pass. One major obstacle that still exists for physicians is the significant financial investment required to make the switch to electronic records. A modest EMR system can cost upwards of $200,000-300,000 when you factor in the software, hardware, training, and ongoing technical support. Many physicians find it difficult to justify this kind of capital expenditure without the assurance of a hefty return on their investment.

In recent years, government agencies and private interests alike have launched efforts to encourage the medical community to adopt EMR systems, and ultimately, to buy into regional or national EHR repositories. Incentives have included grants for physicians, various ‘pay for performance’ initiatives, and the creation of non-profit organizations tasked to develop the technological infrastructure needed to facilitate the storage and exchange of what could eventually amount to billions of records.

Still, many providers remain wary of the prospect of adopting EHR systems. Despite the myriad benefits attributed to EHR by its supporters, there have been a number of well-documented failures, some of them on a grand scale. One case in point is the Santa Barbara County Care Data Exchange, a non-profit EHR program launched in 1999. Developed and managed by leading EHR experts, the program was initially touted as a role model for the health care industry. However, after 5 years, $10 million, and no discernable progress, the plug was finally pulled on the project. While many area doctors converted to EMR systems during the pilot program, the ultimate goal of sharing patient information among providers was never fully realized.

Other critics have voiced concerns about the legalities of shared patient information, a crucial issue in today’s litigious culture. The legal system—notoriously slow in responding to new technological developments—is still trying to resolve the thorny issue of how liability will be assigned when patient information is shared between numerous providers.

Finally, skeptics argue that the main roadblock to the national roll-out of a viable EHR network is the inevitable loss of productivity—and profit—as medical providers and their staff across the country struggle with the learning curve associated with a large-scale technology change. Despite the promise of this technology, it remains unclear whether these practical obstacles to widespread implementation will be addressed in the foreseeable future.