Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era

This follow-on article moves the discussion forward by adding further dimension to the issue of unintended consequences from the perspective of the United States health system.

Unintended Consequence 3: Innovation Vacuum

As EHR adoption has primarily been achieved through financial incentives, the cycle of technological innovation typical of other industries has not been observed in the US HIT sector. As a result, commercial EHRs were adopted before fixing widely known problems such as poor usability, which has been associated to patient harm, and suboptimal clinical decision support (CDS) systems such as excessive, overzealous alerts frequently ignored by providers. In addition, a recent evaluation of EHR certification criteria concluded that the certification process is not designed to prevent patient harm. Specifically, the report found that the usability testing required does not include a representative sample, does not include real clinical scenarios, and does not simulate changes added through system configuration by local clients.

The accelerated adoption also affected benchmarking organizations such as Intermountain Healthcare, Partners Healthcare, and the Veterans Health Administration that have traditionally promoted most HIT innovations. These organizations decided to replace their systems with commercial EHRs, putting an end to the homegrown systems' era. As a result, some of these organizations decided to dissolve their informatics departments, decreasing their investment in informatics innovation.

With widespread adoption of suboptimal and poorly tested systems, along with traditional innovators stepping aside, fixing the EHR now is a bit like fixing an airplane midflight, and without a pilot.