On Feb. 17, 2009, President Barack Obama signed legislation that created the federal government's meaningful use electronic health records incentive program. Nearly 10 years and $35 billion in federal incentives later, hospitals and health systems are still struggling with EHRs, as new installations disrupt workflows and cost millions of dollars, eating into their bottom lines.
Earlier this month, Trinity Health reported a $107.8 million asset impairment charge for its fiscal 2018 related to its hospitals and continuing-care facilities switching to a single version of Epic EHR and revenue cycle management software, a four-year project with an undisclosed cost. Trinity officials said they were not available to comment.
The federal government fed the initial investments in EHRs. Through May 2016, it poured $34.7 billion into incentives for adopting EHRs, money that many health systems went after. As a result, hospitals and health systems spent millions and sometimes billions of dollars each to install new health record-keeping software.
A newly live Epic EHR installation at the Mayo Clinic, for instance, made up a chunk of the health system's overall $1.5 billion investment in new technology. Partners HealthCare spent $1.2 billion on an Epic EHR, with installation beginning in 2015. And Scripps Health ran into some EHR-related road bumps a few year ago, reporting weakened financial results as it readied an EHR conversion budgeted for 10 years to cost just over $300 million and expected to incur $360.5 million in operating costs.
Once installed, EHRs are supposed to help hospitals and health systems clinically and financially, making them more efficient. But the benefits along those lines have been elusive. The software can sometimes work against hospitals and health systems, some of which have taken financial hits from the cost of implementation, driving up operating expenses.
There are signs that the industry has had enough. Allied Market Research estimates that the growth in global revenue spent on EHRs, while significant, may be slowing. While opportunities in “untapped markets” remain, “high cost of EHR software and increase in concerns related to safety and security of data have hampered growth of the industry,” according to the firm. The research firm expects the global EHR market to grow an annualized 5% per year to $33.3 billion by 2023, from $24.9 billion in 2017.
In addition, physicians and other clinicians, key users of EHRs, have generally been wary of embracing the software and may feel held back by having to use the systems, feeding into clinician burnout. “Where the debate about EHRs still comes in is doctors changing the way they practice and spending an awful lot of time doing data entry type of things,” said Michael Burger, senior consultant at Point-of-Care Partners. “They push back to say, 'We've made this enormous investment, and in the end, I'm not sure the care I'm providing is any better or less expensive than if I were doing it on paper.' ”
According to a literature review recently published in the Journal of the American Medical Informatics Association, “although no one suggested going back to paper, this study provides evidence that data entry requirements, inefficiently designed user interfaces, insufficient health information exchange from outside institutions, information overload, and interference with the patient–physician relationship are … factors associated with physician stress.”