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The Challenge Of Using Health IT More Effectively

Thu, 08/29/2013 - 9:50am
Ashish Jha, M.D, M.P.H

Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.”  This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system.  But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were we going to get there?

We were essentially starting from scratch.  Less than 1 in 10 hospitals had an electronic health record, and for ambulatory care physicians, the numbers weren’t much better – about 1 in 6 had an EHR.  Hospitals and physicians reported an array of challenges that were holding them back.  No nation our size with a healthcare system as complex as ours had even come close to universal EHR use.  Yet, the president was calling for this by just 2014.

And it was clear why.  The promise of EHRs was enormous and we knew that paper-based records were a disaster.  They lead to lots of errors and a lot of waste.  I have cared for patients using paper-based records and using electronic records – and I’m a much better clinician when I’m using an EHR.  In the weeks that followed Obama’s inaugural address, the U.S. Congress passed, and the president signed the Health Information Technology for Economic and Clinical Health Act, which contained a series of incentives and tools to drive adoption and “meaningful use” of EHRs. None of us knew whether the policy tools just handed to the Obama administration were going to be enough to climb the mountain to universal EHR use.  We were starting at sea level and had a long climb ahead.

Recently, just about 4 years after the passage of HITECH, Health Affairs and the Robert Wood Johnson Foundation held a briefing about where we as a nation are vis-à-vis health information technology.  Mike Painter, who is the RWJF lead, captured it perfectly in his reflection that when you climb a mountain, it’s important to take breaks, celebrate the progress, and enjoy the vistas.  July 9 in Washington DC was just such a moment.  It was a day to celebrate how much progress we have made.  No “Mission Accomplished” banners.  Just a day to take a breath and say – we are off to a very strong start.

Why do I say this?  In 2008, 9% of U.S. hospitals had at least a basic EHR.  In 2012?  That number is 44%.  A staggering near 5X increase in 4 years.  And the gains on the ambulatory care side have also been impressive.  What’s more, the numbers suggest that HITECH led to an inflection point – it catalyzed the adoption of EHRs across U.S. hospitals.  This is the proportion of U.S. hospitals with at least a basic EHR:

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