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

The Path Forward

At least 2 panels at recent American Medical Informatics Association annual symposia have presented informatics innovations in the post-MU era with clients of 1 large HIT vendor, and most innovations included SMART on FHIR apps. Panelists have pointed out that as commercial EHRs can properly handle capabilities such as billing, data storage, and privacy regulations, informatics innovators tend to be freer to innovate in the post-MU era. However, as previously mentioned, most HIT vendors are not yet fully open to seamless interface with external apps. In addition, FHIR is a standard under development, and a substitute for the traditional innovators is yet to be found. To aggravate the problem, most contracts signed between providers and HIT vendors include clauses that hamper transparency by preventing providers from sharing usability and safety issues that could otherwise advance EHR design.

There was a natural reason for having most HIT innovations coming from benchmarking organizations: neither HIT vendors nor academic departments have seamless access to clinicians at the point of care, where informatics applications are put to the test. In naturalistic settings, iterations between clinicians and informaticists facilitate an understanding of users' needs to inform EHR development. Academic informatics departments could serve as a natural replacement for the traditional innovators by promoting cutting-edge research toward fixing the EHR, coupled with more robust HIT evaluations. However, this replacement will demand a closer relationship between academic departments and their medical centers. In US universities, these departments tend to function as independent organizations, which hampers researchers' access to HIT resources and clinicians at the point of care. Work in such a direction has started and serves as example of the path needed to design new business models, fostering innovation and transparency, and fixing the EHR.