Viewpoint Paper: Promoting Electronic Health Record Adoption. Is It the Correct Focus?

In 2004, President Bush set as a goal that every American would have an electronic health record by 2014. In the three years since that pronouncement, the Department of Health and Human Services (DHHS) has established the Office of the National Coordinator for Health Information Technology (ONC), and the American Health Information Community (AHIC) to oversee policy. It has set priorities and has anointed two existing organizations, the Health Information Technology Standards Panel (HITSP) and the Certification Commission for Health Information Technology (CCHIT), to play significant roles in establishing and promoting the standards necessary to achieve this goal. One theme that pervades all of the organizations involved in this broad mandate is the promotion of the adoption of electronic health records (EHRs) by physicians—a perennial issue with which the healthcare informatics community has struggled for several decades. The problem of slow EHR adoption by physicians has been described in the informat-ics literature as " the wave that never breaks. " 1 With the emergence of the national mandate of the current administration to promote the adoption of EHRs, the introduction of legislation in Congress to fund EHR adoption and the focus of some of the 2008 presidential candidates on healthcare IT as a component of their healthcare plans, there is every indication that the wave could finally break before the end of this decade. It is therefore timely to ask if this is in the best interests of the country. The reason that EHRs are being promoted by this administration and many others is the assumption that they can be useful tools in promoting quality and reducing costs. The premise is that the ready availability of legible patient clinical information to physicians at any place and any time would reduce errors of omission and commission resulting from the lack of such availability in the prevailing paper-based records environment. The addition of clinical decision support functions in many EHRs to alert physicians to potential errors and influence their behaviors toward evidence-based decisions further enhances the potential of EHRs to promote quality and reduce costs. All of these positive aspects of EHRs have been widely documented over several decades in the broad healthcare informatics literature and particularly in JAMIA. These will not be reviewed here. The focus of this commentary is to question whether the current policy of promoting EHR adoption is appropriate given the current state of EHRs in the marketplace …