Achieving the vision of EHR--take the long view.

IN THIS SPECIAL issue of Frontiers of Health Services Management, Rosemarie Nelson and Michael Sachs discuss various themes pertaining to the adoption of electronic health records (EHRs) and the creation of the National Healthcare Information Infrastructure (NHII). These are exciting times for healthcare-the adoption of healthcare information technology (IT) will undoubtedly be a major part of the transformation of U.S. healthcare delivery. While the opportunity is vast, the challenges are many. It is wise for healthcare managers and leaders to take the long view on this journey. In this commentary, I comment briefly on the salient points made by Nelson and Sachs, and then offer my perspectives on key points in the adoption of health IT, and management perspectives critical for our collective success. Rosemary Nelson, an accomplished leader and change agent in healthcare, describes several key factors for successful adoption of health IT. First, dear objectives for IT adoption must be stated, and these measures of success-both clinical and financial-must be meaningful to all participants. Planning is critical, not only in defining IT requirements and selecting appropriate technology, but also in implementing and training people to use the new technology. "The EHR is a change-management process" states Nelson-both when implementing EHR the firsttime, and when using the technology as a platform for process redesign and care reengineering. Nelson would suggest that change management necessarily implies an incremental approach to technology adoption and process redesign. Finally, Nelson points out that the patient connection is critical not only for IT adoption but ultimately for the care redesign process as well. Michael Sachs, an accomplished healthcare strategist and visionary, describes several of the fundamental forces changing the nature of the U.S. economy and their potential impact on the U.S. healthcare delivery system. The World Wide Web (WWW) allowed creation of new approaches to business models-many fiscal and functional intermediaries were removed in the process of disintermediation, whereby the WWW allows more direct connections to occur between suppliers and potential customers. Mass customization allowed the hypersegmentation of consumer marketplaces essentially to the individual level-each person could customize his or her favorite web pages and get personalized recommendations for his or her online shopping. Sachs describes how modern medical technologies beyond IT are transforming medical practice, most notably the advances in medical imaging. However, the advances in our understanding of the human genome, and the relationships between our individual DNA maps and disease and treatment, are what will allow mass-customization to occur in healthcare in ways akin to what we have seen with the WWW. Sachs maintains that we are at the advent of a "golden information age" in healthcare as a result of the increased application of IT and the ability to personalize healthcare treatments based on the understanding of the human genome. ACHIEVING THE VISION OF EHR ADOPTION Three key points need to be kept in mind when considering how to best achieve the vision of EHR adoption and the transformation of healthcare in the United States. The evidence base is now overwhelming: using EHR in clinical practice saves money for individual practitioners, key stakeholders in healthcare, and society as a whole. Functionality and Interoperability Savings only happen, however, when two things are true: (1) when a robust EHR with appropriate features and functions (including clinical decision support) is used in practice, and (2) when EHR systems can interface with other systems, or readily exchange clinical information with other caregivers providing patient care or services. A Robust EHR First, therefore, robust EHRs must be implemented and used in practice. We have a dear understanding of a "robust EHR" from many sources. …