Brookings Institution Forum

Panel: EHR Holds Challenges Along With Promise

March 20, 2015 12:23 pm Michael Laff Washington, D.C. –

A panel of health IT experts who spoke during a recent Brookings Institution forum( said electronic health records (EHRs) have not reached their full potential largely because competition among vendors hampers interoperability and small practices have difficulty with the systems' requirements.

Karen DeSalvo, M.D., M.P.H., director of the Office of National Coordinator for Health Information Technology and HHS acting assistant secretary for health, discusses technology use in health care during a recent conference.

The event, which was hosted by the institution's Engelberg Center for Health Care Reform, came shortly before AAFP President Robert Wergin, M.D., of Milford, Neb., shared similar concerns in testimony( before the Senate Committee on Health, Education, Labor and Pensions.

Panelists Call for Training, Adjustment Period

Panelist A. John Blair III, M.D., CEO of MedAllies and director of Taconic IPA, a large physician group in the Hudson Valley region, said that about one-third of the group's physicians and other health care professionals are using electronic records effectively, one-third need additional training, and the final one-third are struggling. A large percentage of ambulatory care centers are not using EHRs at all, which hampers data-sharing, he said. Most of the gaps can be attributed to a lack of training at the practice level.

Story highlights
  • Panelists who spoke during a recent Brookings Institution forum said that although electronic health records (EHRs)are intended to make patient care more transparent, compliance requirements can be a burden.
  • Small practices may have difficulty implementing EHRs because of the cost and time required, panelists said.
  • Competition among vendors stands in the way of sharing data.

Despite some struggles adopting the technology, Blair said it is too early to evaluate policy regarding interoperability. He cited research that examined three groups of health care professionals: those who used paper records, those who used EHRs and those who had made the transformation to the patient-centered medical home (PCMH).

"We saw no difference in quality and cost between paper and EHR," he said. "But once they went to advanced primary care, there were significant improvements in cost and quality. They could not have done that without these systems that are being deployed today."

Some panelists said an adjustment period would help practices use EHRs effectively.

"We need a respite from policy," said Mark Segal, Ph.D, vice president of government and industry affairs at GE Healthcare IT. "We need a (time)span for vendors and users to adapt to the changes. Nobody knows the right approach to population management."

Although CMS gives physician practices some flexibility to meet meaningful use standards, the panelists said they think the agency should offer more leeway, especially for small practices that need to devote more office time to developing electronic platforms that patients can access.

Marc Bennett, M.A., president and CEO of HealthInsight, said many practices will need technology infrastructure that lets them manage their entire patient population if they decide to transition to a PCMH, an accountable care organization or an advanced practice.

Giving individuals easy access to their own health records is still a long-range goal.

"If patients were able to get their data in real time in a detailed electronic format and allow a designated third party to collect it on their behalf, we would have the problem solved," said David Brailer, M.D., Ph.D, the nation's first director of the Office of the National Coordinator for Health Information Technology (ONC). "This is not a patient-centered (Health Insurance Portability and Accountability Act) environment and until it is, the world we live in will be technically capable but perhaps not really used."

"Capturing the Whole Picture" Is Key

Panelist Karen DeSalvo, M.D., M.P.H., current ONC director and HHS acting assistant secretary for health, said the department recognizes that there is a growing "digital divide" as smaller and rural practices have fallen behind in using EHRs to their full potential.

Many EHR goals are being met, said DeSalvo, but the records are not "capturing the whole picture" including behavioral health aspects and long-term, post-acute care needs.

Robert Wah, M.D., president of the AMA, recommended restoring EHRs to their original function as a patient record.

"It became not just a medical record to record clinical findings but a vehicle for regulatory compliance, financial billing and strategic planning," he said. "All these other jobs were put on the electronic health record. One of the frustrations for physicians is that we are expected to feed that system with a lot more than just clinical data."

Wah said interoperability is hampered by vendor competition.

"We're kind of like where the telephone companies were when cell phones came out," Wah said. "AT&T could not call Sprint. Interoperability was not seen as the first priority. We have to stop trying to build the biggest network."

Farzad Mostashari, M.D., CEO of Aledade and a past ONC director, noted that incentives are available for physicians to share data, but not for vendors.

Panelists' Concerns Mirror Wergin Testimony

In his Senate testimony about EHRs, Wergin outlined many concerns that primary care physicians encounter with electronic records, including burdensome documentation requirements.

"The current standards are time-consuming, lead to bloated medical records which emphasize billing information rather than helpful and important clinical data," he said.

Nevertheless, the capability of EHRs can be utilized in the right setting, Wergin said.

Citing recent research findings, he said that overall quality improvement in PCMH practices with an EHR was 7 percent higher than in paper-based practices and 6 percent higher than in non-PCMH practices with an EHR.

"EHRs could improve care coordination between primary care physicians and subspecialists, hospitals, pharmacies, labs and state health departments -- but this is not possible now in any meaningful way," Wergin testified.