Vital Signs Blog

Blog: EHR adoption is a great success! Except that docs still hate them

LAS VEGAS—Andy Slavitt and Dr. Karen DeSalvo played a bit of good cop, bad cop at the Healthcare Information and Management Systems Society convention on Tuesday.

DeSalvo, the national coordinator for health information technology at HHS, emphasized “remarkable progress” providers have made in adopting electronic health record systems. Slavitt, the acting CMS administrator, countered in a talk right after hers that physicians continue to complain about the EHR systems they're struggling to use.

Before the $31.9 billion in federal incentive payments began flowing in 2011, only 2 in 10 physicians and 1 in 10 hospitals were using EHRs. Since then, “essentially every hospital” and three-fourths of all physicians use an EHR, and the nation is “near achieving” the goal set by President George W. Bush in 2004 and reaffirmed by President Barack Obama that every American should have an electronic medical record.

DeSalvo did add, however, that the nation needs to work harder on reforming the care delivery system in order to get the “digital dividend” on the investment.

To promote interoperability, DeSalvo said, the ONC Tuesday announced two mobile app challenges of $175,000 each—one to be awarded for a consumer app and the other for an app for clinicians.

Another $275,000 is earmarked for the development of “an open resource”—DeSalvo referred to it as a website—“to make it easier for developers to publish their apps and for providers to discover and compare them.”

The initiative will leverage Health Level 7's Fast Healthcare Interoperability Resources, or FHIR, interoperability standards and protocols and the use of open, standardized application programming interfaces, or APIs.

The ONC's final rule on the so-called 2015 Edition EHR testing and certification criteria includes API criteria.

Slavitt, a familiar face at HIMSS as a former executive vice president of Optum, the healthcare IT arm of insurance giant UnitedHealth Group, said he and DeSalvo exchanged speeches before the HIMSS appearance. She responded to his prepared text in an e-mail. “Andy, I think your speech comes across as very negative,” she wrote. “Why don't you reread with that lens?”

“I erased the e-mail I was writing to send to her and sent a smiley face,” Slavitt said.

Slavitt said he has been listening to physicians complain about EHRs that are too hard to use. “We're still at the state where technology often hurts rather than helps physicians provide better care,” while federal regulations, “in their current form slow them down.”

On a giant auditorium screen Slavitt projected excerpts from e-mail messages he has received. “Nobody's EMR talks to someone else's EMR,” one physician wrote. Another said, “To order aspirin takes eight clicks on the computer. To order double strength, it takes 18.”

“I've got several hundred more,” Slavitt said. “The good news is, they're not describing problems we don't know how to solve. That's what makes Karen and me optimistic.”

Slavitt said the agency has developed a “user-centered design” approach to rulemaking for the Medicare Access and CHIP Reauthorization Act of 2015, but the CMS is still “a few months away” from having any details on the rule.

Slavitt also pledged—to sustained applause—that, “Finally, we're going to wire up long-term care, substance abuse and behavioral health,” all three of which were sidestepped by Congress in the EHR incentive payment program folded into the 2009 stimulus package.


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