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Taking an aggressive stance on EMRs: lessons from the US and UK

May 26, 2014

Michael Guerriere, Justin Kim
From IV Newsletter Spring 2014

The US has an aggressive approach to ‘meaningful use’ of electronic medical record (EMR) technology to deliver better patient outcomes. The UK takes it a step further. Should Canada follow suit?

Canada has spent over $10 billion towards the implementation of electronic health record (EHR) technology, according to the Auditor General’s report in 20101. Much of this money has been spent on developing the infrastructure to store, retrieve, and share health information across the country. However, considerably less government funds have been used to incentivize the use of advanced electronic medical records (EMRs) by primary care providers.

Canada ranked second-last among 10 developed countries in EMR use in a 2012 survey by the Commonwealth Report2. Only 10% of physicians in Canada said they used EMRs with multifunctional health information technology (HIT) capacity (“multifunctional HIT capacity” is defined for the purpose of the Commonwealth Report survey as at least two electronic functions for each of order entry management, generating patient information, generating panel information, and routine clinical decision support).

Figure 1:
Doctors with Electronic Medical Records and Multifunctional Health IT Capacity

Source: Commonwealth Report, 2012 

Canada’s low EMR adoption rate may in part be related to the past focus on subsidizing the purchase and implementation of EMR technology typically with a one-time payment of incentive dollars. Healthcare providers were encouraged to implement EMR technology; however the meaningful use of technology or improved patient outcomes as a result of technology were not linked to incentive dollars in most provinces.

In contrast, the United States has taken an aggressive and standardized approach towards the meaningful use of EMR technology: incentives and penalties are significant, adoption is mandatory, and payments are tied to the meaningful use of technology. A three-stage Meaningful Use incentive program, with increasing levels of HIT functionality and increasing emphasis on patient outcomes, was established at the federal level and put into effect in 2011.

To be considered a “meaningful user”, physicians and hospitals must consistently use a growing list of advanced HIT functions such as e-prescribing, generating patient reminders for preventative care, allowing patients to access their health information electronically, and using specific clinical decision support functions. Over $18 billion in financial incentives were set aside and all eligible providers and hospitals across the US were then given advanced notice (up to four years) to prepare for the impending changes3.

In another notable contrast to Canada, the financial incentives for US physicians and hospitals are significant over the 6 year program: an average physician can receive up to $44,000 in incentives for Medicare patients or up to $63,750 in incentives for Medicaid patients, and hospitals can potentially receive millions of dollars4.

Furthermore, the financial incentives were accompanied by an announcement that failure to meet the Meaningful Use requirements would result in reductions in fee for service remuneration rates starting in 2015. The payment adjustment is 1% and is cumulative for every consecutive year the physician fails to meet the requirements of Meaningful Use. These reductions would have an ongoing impact on physician incomes, making adoption of technology a very compelling investment. Implicit in these rate reductions is recognition that care delivered without information tools is no longer the standard of practice and hence is not as valuable to the public payer.

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