Electronic Health Records

Adoption & Implementation News

Have EHRs, health IT adoption really made progress since 1990?

By Jennifer Bresnick

With a tablet on every countertop and a smartphone in every pocket, it may seem silly to question the progress technology has made since twenty-five years ago, when many of today’s medical students were still in diapers.  But a compilation of the past quarter century of HIMSS Leadership Surveys, released in honor of National Health IT Week, calls into question just how much we have achieved since physicians started making predictions about computers in the consult room way back in 1990.

EHR and health IT adoption

In 1992, respondents to one of the first surveys thought that computer-based patient records would be just five to ten years away from successful implementation in healthcare organizations.  It would take seventeen years for the ONC to introduce the EHR Incentive Programs (2009), and more than twenty years for EHR adoption to reach 50% of all organizations (2013).

In 2005, EHR adoption had reached 18% of providers.  By 2008, that number had jumped to more than 40 percent.  Today, some states and provider types have achieved nearly universal EHR implementation.  Financial viability after massive technology investments and a pressing need to meet meaningful use, ICD-10, and other federal requirements have overtaken EHR adoption as a main business concern.

Physician satisfaction with health IT

The early 1990s also levels of physician resistance and skepticism towards health IT that may be familiar to some holdouts today.  In 1991, just 22% of physicians were “open minded” about new computer technologies, and 23% of respondents said that one of their top IT problems was how often physicians complained about the usability of their computer systems.

Interoperability and health information exchange

Thirty-nine percent of physicians in 1994 predicted a fully operational nationwide health information exchange network would exist by the year 2000.  Fourteen percent predicted that the widespread sharing of patient records was only one to three years away.

By the mid-nineties, providers were first running into the brick wall of systems integration, and began to cite a lack of interoperability as one of their chief challenges.  Integration was ranked more important than computerized records integration in 1995, and again in 1998, even though only 2% had already successfully implemented a fully operational computer system.

Quality, safety, and new technologies

The late 1990s saw the beginning of a shift towards leveraging basic computer technologies to improve the quality and safety of healthcare.  By 1999, telehealth and the transmission of medical images to external sites because a top usage of health IT, and the top clinical challenges of the previous year included how to extend diagnostic services to care givers in remote locations.

After the bursting of the Y2K bubble, providers turned their attention to reducing medical errors, which was a top-three priority response in 2002, 2004, and 2005.  The second half of that decade also saw bar coded medication management emerge as an important quality issue, while the first mentions of computerized provider order entry (CPOE) emerged in 2007.

Stage 1 and Stage 2 Meaningful Use

In 2009, with the passage of the American Reinvestment and Recovery Act (ARRA), the phrase “meaningful use” starts to take over. The codified approach to quality, safety, and technology improvements consumes the attention of providers to this day, and brings us into the modern era of health IT.  HIMSS reports that 71% of providers plan to attest to Stage 2 by the end of 2014, following a 66% success rate in Stage 1 attestations from the previous year.




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