Introducing incentives for EHR adoption as part of the stimulus law was definitely the right thing to do. There was a momentary opportunity to advance health IT with significant funding and the Obama Administration went for it. But a downside is that the systems that were ready to go were pretty weak by the standards of IT overall.
IT systems used were found to be inadequate. Nearly all sites’ records lacked capabilities to flag patients as candidates for decision aids or to track patients through the process, such as whether the post-decision aid conversation had taken place. Though some sites used questionnaires to gauge patients’ values and preferences, there was no way to integrate that information into the clinical system, meaning that information had to kept separately and might not be available to the physician conducting the post-decision aid conversation.
None of the sites had an IT system that tracked whether the patient received care in accordance with his or her stated preferences. Those involved at the care sites suggested automating as much as possible the process of flagging patients to be given decision aids and handing that task over to a staff member other than the physician.
If you’ve worked with health IT systems, the situation described here will come as no surprise. But challenges like this are being addressed outside the health care system. Take Board Docs for example, which provides cloud-based document management systems specifically aimed at boards of directors. Read the list of features and you’ll see that it deals with a lot of the common challenges associated with preparing and managing board meeting materials. It’s a different set of challenges than what doctors and patients face in shared decision making, but the level of complexity and coordination is similar.
The good news is that physicians are being exposed to what really good health IT is, even if it’s not in their medical practice. They have iPads and smartphones, and use social networks in their personal life. If they serve on a board they may be exposed to Board Docs or similar services.
All that means that we can expect physicians to start demanding state-of-the-art tools in the office, and not put up with what the health IT industry has offered to date.