Driving on Main Street: the road to widespread physician EHR use.

TO THOSE OF US physicians who have long worked to encourage the use of electronic health record systems and other health information technology to improve care, what once felt like the frontier is feeling more and more these days like Main Street-during rush hour no less. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, with its time-limited funding to help offset the cost of implementing such systems, largely contributed to the recent surge in interest and activity in electronic health record (EHR) adoption and meaningful use. HITECH has also increased physicians' sense of urgency by drawing attention to looming healthcare payment reform, giving notice that organizations that lack qualified EHR systems containing data that prove and improve healthcare quality and value likely will suffer financially. Physicians newly interested in achieving EHR meaningful use may be reacting to different and transient forces than those of us who were out on the health information technology (IT) frontier. It is important to ensure that these physicians can align with the success principles that motivated leaders of successful EHR implementations in the days before HITECH, including those visionary CEOs who described their experiences in the feature articles. These correct principles are independent of any time-limited stimulus incentives and persist long after the EHR meaningful use incentive dollars are gone. MOTIVATING HOSPITAL AND HEALTH SYSTEM LEADERS The feature articles are replete with important rationales, insights, and advice from CEOs nationally recognized for their successful EHR system implementations. The authors' comments can serve as a useful reference for fellow CEOs leading their own boards, leadership teams, physicians, nurses, and other health professionals to work to achieve the health IT-enabled care transformation they see as essential to patient care quality and organizational excellence. M. Michelle Hood points out the critical importance of realizable, real-time, consequential exchange of information enabled by health IT, as well as the need to properly frame EHR implementations as transformative clinical care redesign initiatives rather than as IT projects. She also underscores the importance of responsiveness to business climate issues while promoting participative decisionmaking structures, communication, collaboration, process redesign, standardization, and frequent reporting on important processes and outcomes. Meanwhile, CEOs David Bernd and Peter Fine, who lead organizations nationally recognized for their successful implementation and productive use of advanced health IT systems, provide cautions regarding the unsustainable nature of the current healthcare delivery system, the precarious prospects for those who change too little or too slowly in the face of needed reform, and the capacity EHR systems possess to empower improved patient outcomes and costs when integrated into clinical practice. While their organizations are shining examples of the profoundly positive impact that successful EHR implementations can bring, Bernd and Fine are realistic in describing important barriers encountered on their EHR journeys and suggestions for reaching the next horizon. PHYSICIAN ENGAGEMENT: ONE KEY TO EHR SUCCESS Ultimately, no effort to achieve health ITenabled care transformation will succeed unless physicians - whose orders trigger most determinants of healthcare quality and costs - are meaningful users of robust EHR systems that support desired improvements in quality and value. While physicians on the whole have been slow to implement EHRs, we are not necessarily resistant to information technology in general or even to certain aspects of health IT use. Like other consumers, most of us increasingly use some combination of electronic technologies, such as digital cameras, ATMs, smart phones, digital media, GPS devices, social media, online reservation sites, airport check-in kiosks, and barcode scanners or credit card readers at grocery checkouts. …