EHR Incentives Available. Will Hospitals Take the Bait?

Lisa Eramo , April 13, 2009

If you've read the American Recovery and Reinvestment Act (ARRA) of 2009, you know that the money is in EHRs. But are hospitals really focused on implementation these days, and what are some of the major barriers?

A quick Google search for this information reveals a barrage of articles, many of which yield somewhat conflicting statistics. Consider the March 25 online report published by the New England Journal of Medicine that indicates hospitals are definitely behind the eight ball when it comes to EHRs. Only 1.5% of the 3,049 U.S. hospitals surveyed had a comprehensive system (i.e., it includes hospital-wide clinical documentation of cases, test results, prescription and test ordering, plus support for decision-making that includes treatment guidelines).

"This is mostly because physicians are resistant to adopt EHR technology that changes their work patterns," says Kelly McLendon, RHIA, president of Health Information Xperts, LLC, in Titusville, FL.

"The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology," states the report.

Scroll down through Google's hit list, and you'll see that alternatively, the 20th annual Healthcare Information Management and Systems Society Leadership Survey found that EHR implementation and computerized physician order entry (CPOE) are top priorities for health information technology (HIT) professionals. HIMSS announced the results of the survey in an April 3 press release.

Of the 304 respondents—many of whom responded prior to President Obama's February 17 signing of ARRA—31% said the primary focus would be ensuring their organization has a full EMR. Seventeen percent said the primary focus would be the installation of a CPOE. To assess the impact that the ARRA will have on HIT spending, HIMSS is gathering additional information from survey respondents, according to the press release.

At NorthShore University HealthSystem in Evanston, IL, EHR adoption and CPOE have been top priorities since 2001 when the system began its implementation process. Physicians were on board with the technology because they were simply told "this is the way we were going to be doing business," says Terri Bunsen, chief privacy officer for the four-hospital and 70 plus physician office health system.

NorthShore is one of two recipients of the HIMSS Stage 7 award that recognizes hospitals for achieving a paperless advanced patient record environment. The award is part of a larger EMR adoption model that HIMSS Analytics uses to track the progression of hospital EMR adoption nationwide.

ARRA specifically references physician order entry and clinical decision support as prerequisites, although the specifics of these requirements remain unknown. And there may continue to be a big question mark until December 31—the date by which the HHS Secretary will adopt an initial set of standards, implementation specifics, and certification criteria.

The available incentives should definitely help to spark widespread adoption, McLendon says, although he admits that CPOE may be the most challenging aspect of implementation. "It [ARRA] gives hospitals millions of dollars worth of reasons to procure good EHR software and mandate adoption," he says. "But the hospital has to have the political will to mandate full use of CPOE and other decision-support tools across the entire clinical and medical staff."

Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing. Contact her at

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