As the debate for health care reform gears up with one of the biggest lobbying efforts ever seen on both sides of the aisle, it may be crucial to examine lessons learned from recent problematic government mandates on the health sector.

Following the Health IT Policy Committee recommendations released on June 16th, which are guided by the Health IT Standards Committee, health care stakeholders are complaining that benchmarks for electronic health record (EHR) adoption under the American Reinvestment and Recovery Act (ARRA) are too stringent and unrealistic.

So what' all the fuss? Of course that depends on the player but the major concern is the time frame to meet the benchmarks, namely achieving computer physician order entry (CPOE) capability by 2011. In layman's terms, this means doctors stop writing orders by hand and start entering orders into a computer, resulting in fewer medical errors due to human reading (or interpretation) error.

For the American Hospital Association (AHA), the CPOE capabilities mandate is their main complaint. In a letter to David Blumenthal (National Coordinator for Health Information Technology, HHS), the AHA argues that CPOE capability is linked to other EHR functions that are complex in their implementation. Additionally, the transition to EHR use by physicians is a cultural change that requires patience and familiarity. The AHA cites that currently only 8-12 percent of hospitals have an EHR system of some sort and many are defined as ‘basic'. Therefore, they argue, the time frame given to them to implement CPOE is too aggressive and bound to fail. Instead, the AHA requests that CPOE requirements be pushed back to 2015. 

The Association of Medical Directors for Information Systems (ADMIS) agrees with the AHA but is more comprehensive it its criticism.  With respect to the adoption issue, ADMIS comments in their June 26th letter to HHS that their fellow physicians are a constituency that require a "crawl-walk-jog-run" evolution in order to attain comfort in using EHR systems. I'm sorry, didn't these people go to medical school? Take organic chemistry?  

All ribbing aside, the ADMIS letter does give direction as to how meaningful use may be attained:1) focus on data capture and data sharing as the pre-eminent goal of meaningful use. In other words, show you can use the technology.2) defer measurement of quality until systems are institutionalized.3) stall CPOE implementation until 2013 because there are too many complex inter-related EHR functions involved in its successful launch. While these recommendations are sincere and forthright with success in mind, they do not accelerate adoption to the levels envisioned by the Obama Administration. They do, however, accommodate physicians and staff in establishing a more comfortable time frame for EHR adoption.

So the final question appears to be: cater to the cultural and administrative concerns of the health care workforce or not? Adoption and acclimatization by providers appears a worry on the minds of many, but are we underestimating how quickly the health care system workforce can learn, evolve and be both productive and efficient? After all, health care providers have an economic bias towards inertia. Is it possible that their whining is only designed to maintain the status quot out of economic interest? Maybe, maybe not. 

Studies do show a decline in productivity with the introduction of EHR software, as much as 10-15 percent over the first several months. Furthermore, technology transformations in the business sector such as those seen in the mid-to-late-nineties with the launch of enormous enterprise systems taught us that trying to create information systems that talk to each other and manage data seamlessly is not only daunting but fraught with expensive fixes and imperfection. That being said, I think (and surely hope) my doc can pick up how to use a new computer program pretty quickly, if only nudged a little.

Also Interesting:

[+] GE offers no-interest loans to promote EHR software

[+] Community Health Centers: An EHR helping hand, please?

[+] States take bigger role in promoting EHR adoption

[+] Doctors aided by emerging offshoot of EHR software

[+] EHRs with the ease of an iPhone? Not so fast