🤔 Adoption of EHRs in the U.S.

❓Adoption of EHRs in the United States? Challenges?

💡Adoption of EHR within the United States healthcare system is above 85%, even among larger entities. However, small and rural hospitals’ adoption rate lags due to a lack of financial support, incentives, and technical capabilities 1. In recent years, the US government has played an instrumental part in EHR advancements and adoption. The federal government took an active role by passing various laws like the Health Information Technology for Economic and Clinical Health (HITECH) Act. These, in turn, promote further meaningful use and adoption of technology. The legal incentive mechanism increases an organization’s guilt and punishment for not fulfilling these requirements. Some countries like Singapore have also experienced increased adoption through government-sponsored incentives 2. However, international adoptions across countries remain widely diverse. For example, third-world countries such as those in sub-Sahara Africa have yet to make substantial progress. The lack of adoption is driven mainly by a lack of finances, technical skillsets, and access to reliable planning and support 3. 

💡Financial incentives, federal laws, and technological advancements drive EHR adoption. In ambulatory EHRs, adoption has been much faster and more accessible due to the smaller scale. Remote doctor visits and Telehealth technologies are quickly becoming more mainstream, driven mainly by ubiquitous smartphone access. More intelligent and capable phone systems combined with high-speed wireless internet services make it possible to provide remote health services anywhere at any time.  

💡The resistance to EHRs adoption stems from high implementation costs, intensive training requirements, change management, and data privacy concerns. Larger and more established hospitals, clinics, and practices are less likely to disrupt their existing processes as they require substantial financial resources, efforts, and technical coordination to utilize newer software. The disruption can lead to many unforeseen challenges and a decrease in internal clinician satisfaction and patients. Overall, the misalignment between incentives, tradeoffs, and efforts necessary seems to stagnate progress.  

💡Aligning financial incentives, legal mandates, training, and support can increase EHR adoption. Lower costs through tax breaks and other incentives should increase an organization’s ability to cope with the necessary change management and its corresponding efforts. Furthermore, additional legal mandates force organizations to prioritize their efforts and assure proper compliance—otherwise, they risk paying financial and regulatory consequences. Lastly, better and easier access to training and support would allow a smoother adoption throughout the change management process. That is because legacy systems have often been in use for many years, and internal clinicians may be unwilling to do things differently even if it means a better process overall. 

📝 References 

1. Adler-Milstein, J., Holmgren, A. J., Kralovec, P., Worzala, C., Searcy, T., & Patel, V. (2017). Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide. Journal of the American Medical Informatics Association, 24(6), 1142–1148. https://doi.org/10.1093/jamia/ocx080 

2. Singapore. (2020). Commonwealthfund.org. https://www.commonwealthfund.org/international-health-policy-center/countries/singapore 

3. Odekunle, F. F., Odekunle, R. O., & Shankar, S. (2017). Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. International Journal of Health Sciences, 11(4), 59–64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654179/ 

4. ‌ EHRIntelligence. (2020, February 5). 3 Strategies to Enhance EHR Usability Through EHR Optimization. EHRIntelligence. https://ehrintelligence.com/news/3-strategies-to-enhance-ehr-usability-through-ehr-optimization 

5. ‌ How will adopting electronic health records improve my ability to care for patients? | HealthIT.gov. (2019). Healthit.gov. https://www.healthit.gov/faq/how-will-adopting-electronic-health-records-improve-my-ability-care-patients 

6. Singapore launches national EHR system; US has 1k EMR companies; (2011, June 23). Fierce Healthcare. https://www.fiercehealthcare.com/ehr/singapore-launches-national-ehr-system-us-has-1k-emr-companies