Accelerating U.S. EHR Adoption: How to Get There From Here. Recommendations Based on the 2004 ACMI Retreat

j J Am Med Inform Assoc. 2005;12:13–19. DOI 10.1197/jamia.M1669. The annual meeting of the American College of Medical Informatics (ACMI) in February 2004 focused on the status of electronic health records in the United States. Attendees at the meeting discussed three questions regarding the state of electronic health record (EHR) adoption in this country: Where have we come from? Where are we today and why? And with widespread adoption of EHR in the United States in mind—How do we get there from here? These discussions have been synthesized into three companion reports addressing each question in turn. In this report, building on the first two, we review discussions and recommendations that focus on the third question. This report represents the opinions of the authors, informed by the ACMI discussions, and does not represent a consensus statement from ACMI. We believe that U.S. health care information technology adoption is stymied by a fundamental health care information technology* (HIT) market failure. The HIT market has failed because of misaligned incentives (asymmetric risk and reward) among key market players, the inability to achieve broad standards adoption and lack of definition of basic product features, and the rapid cycle turnover of HIT companies to date. We identify four broad areas for action to stimulate U.S. EHR adoption. They are: (1) financial incentives to stimulate the EHR marketplace, (2) EHR functional and related informatics standards setting and adoption, (3) enabling policy for EHR adoption, and (4) educational, marketing, and supporting activities. Before we discuss each of these areas in turn, we start by first assessing the current market and business case for HIT in the United States. Addressing a U.S. Health Care Information Technology Market Failure We believe four principal reasons explain the U.S. HIT market failure. These issues must be overcome to facilitate rapid EHR adoption in this country. HIT Value Proposition While a great deal of work has been done demonstrating the impact of clinical information systems on clinical decision making and the quality of care, little work has been done that demonstrates the impact of health care information technology on economic outcomes. Several studies suggest that there should be a positive long-term return on investment for EHR in the ambulatory care environment and a business case for standardized interoperability between EHR implementations, but there is limited solid evidence demonstrating significantly improved financial outcomes resulting from HIT investments. In the absence of solid economic evidence for EHR adoption, most technology vendors make Affiliations of the authors: Clinical Informatics Research & Development, Center for IT Leadership, Partners HealthCare System and Harvard Medical School, Boston, MA (BM); Department of Community and Family Medicine and Department of Biomedical Engineering, Duke University, Durham, NC (WEH); School of Nursing and College of Engineering, University of WisconsinMadison, Madison, WI (PFB); Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA (GFC). Correspondence and reprints: Blackford Middleton, MD, MPH, MSc, Clinical Informatics Research & Development, Partners HealthCare, 93 Worcester Street, PO Box 81905, Wellesley, MA 02481; e-mail: . Received for publication: 08/09/04; accepted for publication: 09/22/04. *We define ‘‘health care information technology’’ broadly as including in patient and out patient care settings clinical information management systems used by clinicians and ancillary staff for the purpose of clinical information management, order entry, documentation of care services, and decision support. 13 Journal of the American Medical Informatics Association Volume 12 Number 1 Jan / Feb 2005