Why have EHRs failed to deliver their promised efficiency benefits?
Why has health technology been so slow to deliver on its promised benefits to hospitals and physicians?
Robert Wachter, MD, hospital medicine pioneer and recently appointed chair of the Department of Medicine at the University of California-San Francisco, cites a “productivity paradox” of information technology, which was advanced in the early 1990s by Erik Brynjolfsson of the Center for Coordination Science at Massachusetts Institute of Technology. It holds that while adoptees of new information technology expect to see a sharp uptake in their productivity from computerization, that uptake can fail to materialize for a decade or more.
Historically, the dividends of productivity-enhancing disruptive technologies are reaped more gradually, following an initial lag, once the opportunities have been fully assimilated and users have learned to rethink the nature of their work and question old ways of doing things. Wachter suggests that this kind of evolution will be true with hospital electronic health records, as well. It may take a decade or more before we see the predicted massive gains in productivity.
Wachter last year published a book on health information technology and its discontents, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. “For 15 years, I studied patient safety. It was logical to believe computers would come in and fix things, making everything simpler, easier and more straightforward,” he says. Wachter discovered that in many cases doctors stopped talking to each other, with something important lost from their computer-facilitated interactions.
“A lot of my colleagues complain that computers have ruined their lives,” he says. “We didn’t understand how complex the transition would be from paper to digital—a massive transition over a short time.”
Wide rollout but high provider dissatisfaction
By conventional measures of success, the rollout and dissemination of electronic health records (EHRs), following more than $35 billion in financial incentives paid out to providers since 2011 by the U.S. government’s Office of the National Coordinator for Health Information Technology, has led to historic gains in adoption of the technology. By 2014, 83% of office-based physicians and 84 percent of hospitals had implemented EHRs, up from 29% and 9% eight and six years before respectively, according to David Blumenthal, MD, MPP, president of the Commonwealth Fund.
“I think of information technology in health care as a resource—like a circulatory system,” Blumenthal says. “The use of the EHR is now the norm in the American health care system—like it or not. It’s an amazing change in behavior and a reflection of getting a recalcitrant system to begin to pivot.” Blumenthal was National Coordinator for Health Information Technology during early implementation of meaningful use incentives under the 2010 Health Information Technology for Economic and Clinical Health (HITECH) Act.