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Defining a workable strategy to stimulate widespread adoption of electronic health records in the United States
Journal of the American Medical Informatics Association
Volume 12
Number 1 Jan / Feb 2005
1
JAMIA
Focus on Electronic Health Records: ACMI Symposium 2004 Editorial Comments
j
Defining a Workable Strategy to Stimulate Widespread Adoption of Electronic Health Records in the United States GREGORY F. COOPER, MD, PHD j
J Am Med Inform Assoc. 2005;12:1–2. DOI 10.1197/jamia.M1706.
This issue of JAMIA contains three articles that are based on discussions held at the 2004 Annual Symposium of the American Medical Informatics Association’s College of Informatics. The College’s agenda for the 2004 Symposium was to discuss and define a workable strategy to stimulate widespread adoption of electronic health records (EHRs) in the United States. The remainder of this introduction provides background information that sets the context for reading the three associated papers in this issue. In September 2003, a general call was issued to the College membership for topics for the 2004 Symposium. On an e-mail discussion list, Dr. Ed Hammond suggested that the Symposium discuss and develop concrete ideas for how to stimulate the adoption of EHRs in the U.S. His suggestion generated dozens of e-mail messages that explored many facets of the issue. It was clear that the topic was of great interest. Dr. Hammond’s suggestion for a symposium theme was accepted by the College’s Scientific Program Committee, which consisted of Drs. Suzanne Bakken, James Brinkley, Gregory Cooper (Chair), Lawrence Fagan, Antoine Geissbuhler, Isaac Kohane, Peter Haug, Alexa McCray, Blackford Middleton, and Frank Sonnenberg. The Committee proceeded to organize the content and format of the Symposium. Particularly helpful in shaping the agenda for the meeting were Drs. Blackford Middleton and Randolph Miller and Mr. Jeff Williamson, who arranged logistical support. The Symposium sessions took place on February 13–15, 2004, at the Paradise Point Resort in San Diego, CA. Approximately 50 College of Informatics members participated in the sessions. Three topics about the EHR were discussed on each of three days: (1) Where are we and how did we get here? (Session
Affiliation of the author: Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA. Correspondence and reprints: Gregory F. Cooper, MD, PhD, University of Pittsburgh School of Medicine, Suite 8084, Forbes Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582; e-mail:. Received for publication: 10/04/04; accepted for publication: 10/06/04.
Chairs: Drs. Don Detmer and Don Simborg), (2) What are the factors and forces affecting EHR system adoption? (Session Chairs: Drs. Joan Ash and David Bates), and (3) How can the College of Informatics best contribute to the widespread adoption of EHRs in the United States? (Session Chairs: Drs. Patricia Brennan, Ed Hammond, and Blackford Middleton). The three papers in this issue parallel the three session topics at the Symposium. Although these papers are based on discussions that occurred at the Symposium, they do not represent an official (or unofficial) position of the College, in that no formal vote of the membership approved their content. In addition, the papers could not present all the ideas that were discussed at the Symposium; conversely, they mention some ideas that were inspired by the Symposium but not specifically discussed there. The first paper, by Berner, Detmer, and Simborg, provides a succinct overview of the history of adoption of EHRs in the United States from the 1960s to the present. The paper notes that prospects seem good for widespread use of EHRs in the United States and explores reasons why a basis exists for optimism today more than in the past. Nonetheless, it cautions that considerable effort will be required to overcome resistance to making such a fundamental change in the health care delivery process. The second paper by Ash and Bates describes some key factors influencing EHR system adoption in the United States, including environmental, organizational, personal, and technical factors. It summarizes relevant survey results, particularly regarding attitudes toward and adoption of computerized physician order entry. The paper contains suggestions for greater education, communication, alignment of incentives, and standardization. Some of these suggestions are discussed in additional detail in the third paper. The third paper, by Middleton, Hammond, Brennan, and Cooper, discusses the Symposium theme of defining a workable strategy to stimulate widespread adoption of EHRs in the United States. It posits that EHR adoption is stymied by a fundamental market failure of health care information technology in the United States. Building on issues presented in the first and second papers, this paper elaborates on reasons for failure, including misaligned incentives among key market
2
COOPER, Widespread Adoption of Electronic Health Records
players, the lack of both broad standards adoption and definitions of basic product features, and the rapid-cycle turnover of health information technology companies. The paper proposes four areas in which advances are likely to facilitate United States EHR adoption: (1) providing financial incentives to the EHR marketplace, (2) setting and adopting EHR functional and related informatics standards, (3) creating policies for EHR adoption, and (4) engaging in educational, marketing, and supporting activities. Each of these areas is discussed in detail.
We are at an exciting point in the evolution of the EHR in the United States. Circumstances are aligning in a way that makes the widespread adoption of EHRs more likely than ever before. The three articles in this issue of JAMIA provide helpful background and suggestions for achieving that longawaited goal. Members of the American Medical Informatics Association, its College of Informatics, and many others are working to make the goal a reality. Although much work remains to be done, it seems clear that the benefits of success are likely to be immense.
Volume 12
Number 1 Jan / Feb 2005
1
JAMIA
Focus on Electronic Health Records: ACMI Symposium 2004 Editorial Comments
j
Defining a Workable Strategy to Stimulate Widespread Adoption of Electronic Health Records in the United States GREGORY F. COOPER, MD, PHD j
J Am Med Inform Assoc. 2005;12:1–2. DOI 10.1197/jamia.M1706.
This issue of JAMIA contains three articles that are based on discussions held at the 2004 Annual Symposium of the American Medical Informatics Association’s College of Informatics. The College’s agenda for the 2004 Symposium was to discuss and define a workable strategy to stimulate widespread adoption of electronic health records (EHRs) in the United States. The remainder of this introduction provides background information that sets the context for reading the three associated papers in this issue. In September 2003, a general call was issued to the College membership for topics for the 2004 Symposium. On an e-mail discussion list, Dr. Ed Hammond suggested that the Symposium discuss and develop concrete ideas for how to stimulate the adoption of EHRs in the U.S. His suggestion generated dozens of e-mail messages that explored many facets of the issue. It was clear that the topic was of great interest. Dr. Hammond’s suggestion for a symposium theme was accepted by the College’s Scientific Program Committee, which consisted of Drs. Suzanne Bakken, James Brinkley, Gregory Cooper (Chair), Lawrence Fagan, Antoine Geissbuhler, Isaac Kohane, Peter Haug, Alexa McCray, Blackford Middleton, and Frank Sonnenberg. The Committee proceeded to organize the content and format of the Symposium. Particularly helpful in shaping the agenda for the meeting were Drs. Blackford Middleton and Randolph Miller and Mr. Jeff Williamson, who arranged logistical support. The Symposium sessions took place on February 13–15, 2004, at the Paradise Point Resort in San Diego, CA. Approximately 50 College of Informatics members participated in the sessions. Three topics about the EHR were discussed on each of three days: (1) Where are we and how did we get here? (Session
Affiliation of the author: Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA. Correspondence and reprints: Gregory F. Cooper, MD, PhD, University of Pittsburgh School of Medicine, Suite 8084, Forbes Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582; e-mail:
Chairs: Drs. Don Detmer and Don Simborg), (2) What are the factors and forces affecting EHR system adoption? (Session Chairs: Drs. Joan Ash and David Bates), and (3) How can the College of Informatics best contribute to the widespread adoption of EHRs in the United States? (Session Chairs: Drs. Patricia Brennan, Ed Hammond, and Blackford Middleton). The three papers in this issue parallel the three session topics at the Symposium. Although these papers are based on discussions that occurred at the Symposium, they do not represent an official (or unofficial) position of the College, in that no formal vote of the membership approved their content. In addition, the papers could not present all the ideas that were discussed at the Symposium; conversely, they mention some ideas that were inspired by the Symposium but not specifically discussed there. The first paper, by Berner, Detmer, and Simborg, provides a succinct overview of the history of adoption of EHRs in the United States from the 1960s to the present. The paper notes that prospects seem good for widespread use of EHRs in the United States and explores reasons why a basis exists for optimism today more than in the past. Nonetheless, it cautions that considerable effort will be required to overcome resistance to making such a fundamental change in the health care delivery process. The second paper by Ash and Bates describes some key factors influencing EHR system adoption in the United States, including environmental, organizational, personal, and technical factors. It summarizes relevant survey results, particularly regarding attitudes toward and adoption of computerized physician order entry. The paper contains suggestions for greater education, communication, alignment of incentives, and standardization. Some of these suggestions are discussed in additional detail in the third paper. The third paper, by Middleton, Hammond, Brennan, and Cooper, discusses the Symposium theme of defining a workable strategy to stimulate widespread adoption of EHRs in the United States. It posits that EHR adoption is stymied by a fundamental market failure of health care information technology in the United States. Building on issues presented in the first and second papers, this paper elaborates on reasons for failure, including misaligned incentives among key market
2
COOPER, Widespread Adoption of Electronic Health Records
players, the lack of both broad standards adoption and definitions of basic product features, and the rapid-cycle turnover of health information technology companies. The paper proposes four areas in which advances are likely to facilitate United States EHR adoption: (1) providing financial incentives to the EHR marketplace, (2) setting and adopting EHR functional and related informatics standards, (3) creating policies for EHR adoption, and (4) engaging in educational, marketing, and supporting activities. Each of these areas is discussed in detail.
We are at an exciting point in the evolution of the EHR in the United States. Circumstances are aligning in a way that makes the widespread adoption of EHRs more likely than ever before. The three articles in this issue of JAMIA provide helpful background and suggestions for achieving that longawaited goal. Members of the American Medical Informatics Association, its College of Informatics, and many others are working to make the goal a reality. Although much work remains to be done, it seems clear that the benefits of success are likely to be immense.