With the year drawing to an end, we can see some remarkable changes that have occurred in the landscape of Health Information Technology (Health IT). Not only have there been intensive debates, both political and administrative, over how health care should be paid for in this country, there have also been the beginnings of significant changes around how health care is delivered.
Health IT plays a very significant role in the changes that lie ahead in this realm – the changes from a (mostly) strictly fee-for-service payment methodology to one that is more performance-based requires the implementation of a robust Health IT platform to support those changes. They cannot be based on clinical practices that rely on paper recordkeeping, and they cannot rely on practices that are disconnected from each other.
What kind of progress have we seen in 2011? At a high level, we can see three main themes that have emerged in this past year. Let’s touch on them briefly here:
1. The federal EHR Incentive Program (Meaningful Use) became active
After a prolonged process the previous 18 months, where the criteria and specifics of the Meaningful Use program were hammered out, the program started making payments to clinicians in 2011.
At first, hospitals were the earliest winners in the Meaningful Use program, particularly those that participated via the Medicaid pathway, as actual attestation of meaningful usage was not needed the first year (only Adoption, Implementation, or Upgrade – AIU).
But by the end of the year, an abrupt increase in Medicare Meaningful Use Attestation also occurred. Though enrollment in the federal program topped 100,000, actual achievement of Meaningful Use was much lower. Over the course of the year, several hundred (up to a few thousand) were able to demonstrate 90 consecutive days of meaningful usage and receive their incentive money. However, by the end of the year, that number rapidly started to climb, and by year’s end many thousand eligible professionals successfully demonstrated their meaningful usage of certified EHR technology.
Our own rather large cohort of clinicians achieved this in December. It is reasonable to assume that those who did not quite get to the thresholds of performance needed for Medicare Attestation in 2011 will be able to do so in 2012.
2. The overall use of EHRs increased significantly
In part spurred by the federal incentive program, and in part due to an overall change in the climate within health care, the move to adopt an EHR became the “irresistible wind” in 2011.
Unlike what some cynics have claimed, the federal EHR incentive program did not merely reward those large hospitals, clinics and integrated networks that already had EHRs – our own and also federal data shows that new adoption of EHRs by smaller practices grew significantly. In fact, most of the growth in recipients of Meaningful Use dollars were in the solo and very-small practice domain.
Federal estimates have shown EHR adoption to have increased from the single-digits of percentage seen the previous years, with little change in that trend seen from that perspective, to one measured anywhere in the 30-50% range. The acceleration in adoption of EHRs in 2011 is one of the big stories in Health IT.
3. Web-based EHRs have become an important option for smaller practices
One of the main reasons that smaller practices have been able to adopt EHRs, and achieve Meaningful Use, has been maturation in the market for web-based EHRs, particularly our free web-based EHR.
By removing the cost barriers, as well as the technology barriers of encumbering a locally hosted server set-up required for traditional locally-installed EHR systems, smaller practices have been able to move to this new platform, and remain competitive with larger systems that have had the advantage. Prior to web-based EHRs, smaller practices were effectively priced out of this market. In 2011, this was no longer the case.
2011 has been a remarkable year for Health IT. We have seen a significant uptick in adoption of EHRs – the so-called “hockey stick” curve – especially by smaller group and solo practitioners. The federal Meaningful Use program came on-line, and thousands of clinicians have participated in this program, having earned their incentive payments this year. This trend will continue in 2012.
A primary reason for this increase in adoption, besides the incentives provided by federal stimulus dollars, has been the emergence of fully-functional yet light-weight free web-based EHRs. The maturation of this segment of the EHR industry, dismissed as “wishful thinking” or “it will never work” in 2009, has been perhaps the biggest story in 2011. Web-based EHRs have become acknowledged as a legitimate, successful option available for medical professionals in 2011. And in the upcoming year, the potential of such an approach to EHRs – the “connecting the dots” and bringing together all the different settings where health care is delivered – will surpass the traditional model. It will become the big story of 2012.
Robert Rowley, MD
Dr. Rowley brings together three areas of expertise, and helps shape Practice Fusion in a unique way. He has been a practicing primary care physician for over 30 years, and as an early EHR adopter, has been practicing without paper charts since 2002. He has been involved in governance and directorship of health care delivery in a managed care setting in California for over 20 years. He also has a strong technology background and helped develop the very first version of Practice Fusion based on tools created for his own practice. As Medical Director of Practice Fusion, Dr. Rowley helps guide the development of the EHR as an essential tool for our doctors, and as a valuable resource for healthcare overall.