The use of "robust" to describe the adoption of health information technology in 2005 was very robust and a tipping point seems to have been reached in the use of the term "tipping point," and -- if your focus was on the federal government and industry advocacy groups -- it appeared that widespread adoption of HIT was inevitable. On the other hand, concerns over cost, implementation downtime, technical support, interoperability and mixed research results kept popping up, offering a cold dose of reality.
Tracking the significant HIT stories of 2005 meant analyzing trends and taking note of individual events. While federal legislation and initiatives from the Bush administration helped introduce the public to the concept of electronic medical records, the devastation caused by hurricanes in the Southern states helped illustrate how EMRs can make a positive difference.
In the aftermath of Hurricane Katrina, thousands of patients lost their medical histories and often had to rely on memory to get prescription drug regimens started again. However, thanks to its extensive history of using EMRs, patients within the Veterans Affairs Department health system survived the storm with their medical records intact. Word about other healthcare institutions whose use of EMRs kept their patients records accessible helped add to the good press HIT received.
"Hurricane Katrina created concerns about data backup and galvanized the notion that electronic medical records are important," said Girish Kumar, founder and vice president of sales and marketing for eClinicalWorks in Westborough, Mass. "From a vendor's perspective, it was validating what we already knew: that we are on a journey and we're traveling in the right direction."
Edward L. Fisher, the new vice president and chief information officer for Norman (Okla.) Regional Hospital, said Katrina showed the necessity of using EMRs.
"I'm in a university town with 20,000 covered lives from all over the place," Fisher said. "It would be nice to know something about them if something happens."
Another major story of the year, Kumar said, was the Bush administration's push for EMR interoperability and certification standards, which he believes will mature and come to fruition in 2006. He added that the efforts show how government and market forces can work together and indicate that there was a demand and a need to move forward in this area.
Dan Michelson, chief marketing officer for the Chicago-based IT vendor Allscripts, noted the "bipartisan star power" behind federal legislation, which included senators Bill Frist (R-Tenn.) and Hillary Clinton (D-N.Y.), Rep. Patrick Kennedy (D-R.I.), and GOP heavyweight and former Speaker of the House Newt Gingrich.
Not all was positive on the government front. The CMS again extended the delay in releasing an EMR system developed by the VA until the end of 2006 because the software is not ready for mass distribution. Release of the system for physician offices -- known as Vista Office Electronic Health Record -- originally was scheduled for July 2005 before being delayed until August. Instead of a full public release, the software was originally shipped to about 10 trial sites for beta testing under the CMS' control.
Kumar said there were also rumors circulating that the CMS might mandate the use of the VOE system an those rumors helped momentarily slow HIT adoption progress.
"There was a time of about two to four weeks where deals went into a freezer and some of them never came back," Kumar said. "I hope we don't have anything on those lines next year."
Another major story was how insurers and employers put major weight behind HIT as part of pay-for-performance programs and other quality-improvement initiatives.
"It's very clear that the biggest driver for change in healthcare is reimbursement," Michelson said.
He said that HIT is factoring into proposed reimbursement changes in two ways: the use of EMRs to document that clinical measures mandated by pay-for-performance programs were utilized and "pay for use" in which physicians are offered financial incentives to use EMRs.
Kumar said that payers are not just pushing for individual HIT applications such as electronic prescribing, but instead are pushing for "full-blown EMRs," and that he thinks this will be an important catalyst to spur adoption.
"Large corporations are like self-insurers and they are pushing EMRs because they think it's going to reduce their price," he said. "Some are actually providing funding because it will help them with workforce productivity and lower healthcare costs for retirees."
Fisher, Kumar and Michelson all agreed that a somewhat unhyped news story of the year was the evolution of the HIT market and changes within physician thinking about using technology.
"We don't have to sell the concept of electronic health records anymore," Michelson said. "We have to sell our product over somebody else's product."
He added that physicians are not looking at IT "in a substitutive way" anymore, meaning they are changing the whole way they practice medicine instead of just continuing to do what they did on paper in an electronic format.
Kumar said that physicians are no longer just buying individual components and are instead looking to implement an entire suite of applications and adopt fully interoperative systems.
"The day of buying 'best of breed' and trying to stitch them all together is going by the wayside," he said.
"It used be 'This is the best prescribing system and it ran on this platform and this is the best lab system and it ran on that platform,'" Fisher explained. "These applications have to be on the same platform."
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