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Effective EHR implementations need real-world input, NCPA report says

Missing from the current EHR implementation debate is a practical discussion about which systems work and which don't, a National Center for Policy Analysis report says.

There's a lot of theoretical debate around electronic health record (EHR) implementation and not enough analysis of practice, according to the National Center for Policy Analysis  (NCPA). Last week the think tank released a report, "Health Information Technology: Benefits and Problems," that drew its conclusions from a broad look at studies and articles published in peer-reviewed journals, mainstream media and online content.

In an interview with, NCPA senior fellow and health economist Devon Herrick said the report's authors found that more entrepreneurial, off-the-Medicare-grid practices -- such as walk-in clinics and telemedicine offices -- already are using health IT systems for clinical information in more sophisticated ways than are their counterparts that are plugged into insurers and Medicare.

"Services formed outside of the third-party payment system, where they were competing on price and expecting cash payment up front, have health IT [both for clinical information and] to improve their business model," Herrick said.

The NCPA, chaired by former Delaware governor and Republican leader Pete du Pont, concluded that current health IT efforts can potentially realize such goals as increasing access to health care and improving quality. The center suggested three initiatives to further accelerate the process.

• Although many experts tout the perceived benefits of health IT, formal evaluations and evidence regarding successful EHR implementation generally are lacking. Giving the market incentives to build to need -- instead of legislating health IT infrastructure -- could more effectively enhance quality of care. Otherwise, current efforts may amount to merely wiring a broken health care system.

A back-of-the-envelope calculation is that 90% of the effort of installing a health IT system is related to re-engineering your processes.

Devon Herrick, senior fellow, National Center for Policy Analysis

• Government-mandated health IT initiatives are not necessarily crafted with the best interests of the physicians who will use them in mind. Physicians might be more willing to get on board with EHR implementation and meaningful use initiatives if the government, employers and insurers were more willing to share the rewards that building out health IT reaps, the NCPA said.

• Although online medical records -- and telemedicine's promise of remote physician visits -- are opening up access to health care, the 50-state patchwork of licensure laws limits the choices of patients and physicians (for example, an emergency-room doctor seeking a specialist's imaging consult, or a patient seeking a second opinion), who otherwise could use the technology to comparison-shop or access more appropriate services in other states. Streamlining this system could drive down costs.

Improving care, Herrick said, will involve simultaneously fixing broken workflows office by office and weaning the health care system off paper through EHR implementation. Such a fix requires a process analysis as a practice gets its new software and hardware up and running.

"A back-of-the-envelope calculation is that 90% of the effort of installing a health IT system is related to re-engineering your processes," Herrick said. "Do you really want to go into the exam room and try to describe your symptoms, talk to your doctor, and ask questions while his face is buried in the CRT or LCD screen as he struggles to find the correct check boxes and pull-down menus on multiple pages required by a system that is not very flexible?"

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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