Monday, April 11, 2016

Electronic Health Records: Top 10 Healthcare Milestone of the Past 40 Years

In a recent article, Modern Healthcare named the top healthcare milestones of the past 40 years.  The top 10 milestones include electronic medical records, as called for by President George W. Bush in his 2004 State of the Union address. President Bush called for universal, portable, electronic health records within a decade.

On April 26, 2004, President George W. Bush formally launched the federal drive to widely disseminate health information technology to improve patient care. The next day, by executive order, Bush created the Office of the National Coordinator for Health Information Technology within HHS. A few days later, HHS Secretary Tommy Thompson named Dr. David Brailer the first ONC leader.

Bush said the ONC should work with private sector healthcare organizations as well as all federal agencies with a hand in healthcare. The goal of the newly-created ONC was to begin work on a national HIT strategy to promote the adoption and use of interoperable electronic health records to enhance clinical decision-making, improve quality, lower costs, reduce errors, improve coordination of care and ensure the privacy and security of patient data.

However, the Bush years of the ONC did not provide funding for the agency. Instead, the ONC was financed by reshuffling HHS' administrative funds. Despite this, adoption of EHRs has tripled in the first 10 years of the ONC and the concept health information exchange is now commonplace.

The second era of the ONC is the big-money Obama era starting with the 2009 American Recovery and Reinvestment Act, with its $2 billion for ONC grant programs. The incentive payment program for adoption of EHRs has paid out $21.6 billion so far.

There are critics of the strong federal role in HIT development, calling the EHR incentive program a market-disrupting “Frankenstein.”

Ross Koppel, a professor of sociology at the University of Pennsylvania medical school, said federal policymakers erred in thinking that “more HIT equals better care and safer care. That assumption has been defeated by their desire to push the technology long before it was ready.” What has resulted, he said, “is a captured market in which vendors create inferior products that the clinicians are obliged to purchase.”

Yet, EHR has still come a long way. Before the ONC, caveat emptor ruled for EHR buyers. Today, virtually all EHR systems sold are tested and certified against a list of functional criteria developed by the ONC. Before the ONC and the EHR incentive program, fewer than 4% of nonfederal U.S. hospitals had EHR systems with computerized physician-order entry. Today, 90% of hospitals have CPOE. Previously, less than 20% of office-based physicians had any kind of an EHR; today, more than 78% do.

Though ONC has had several previous directors and initiatives, Dr. Karen DeSalvo, the current Coordinator, succinctly sums up the ONC’s overarching goal: “Everyone is trying to solve these same three issues—capturing data, freeing it appropriately and then putting it to use.”

The original article by Joseph Conn can be found at the following address:

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