eHealth Reality in North America. Garets D. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. eHealth Reality in North
America
David E. Garets,
President & CEO, HIMSS Analytics
Executive Vice President, HIMSS

2. Expectations, Limits, and Barriers
for EMRs in U.S.
• Expectations:
• Widespread adoption of acute care and ambulatory EMRs, and
“meaningful use” – via first time ever financial incentives and
requirements from the federal government, increasingly
stringent over 3 phases starting this calendar year.
• Interoperable exchange of summary patient data among acute
care and ambulatory providers, payers, health registries, and
patients via health information exchanges
• Limits:
• Perverse incentives – hospitals and physicians get paid for
helping people once they’re sick as opposed to keeping people
healthy
• Hospitals compete against each other – medical arms wars –
most health systems don’t have good economies of scale in IT

3. Expectations, Limits, and Barriers
for EMRs in U.S.
• Barriers:
• Clinician adoption – lack of change management strategies
• Lack of pan-America standards adoption
• Money is tight, in both operating and capital budgets
• There’s a 40,000 – 60,000 person shortage of qualified,
experienced health IT professionals
• Potentially 35% of hospitals have “too far to go” to earn Phase
1 incentives.

4. 2005-2009 US EMR Adoption Model Trends
2005 2009
Final Final
Complete EMR; CCD transactions to share data; Data
Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7%
Physician documentation (structured templates), full
Stage 6 CDSS (variance & compliance), full R-PACS 0.0% 1.6%
Stage 5 Closed loop medication administration .001% 3.8%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 2.5% 7.4%
Nursing/clinical documentation (flow sheets), CDSS
Stage 3 (error checking), PACS available outside Radiology
10.0% 50.9%
CDR, Controlled Medical Vocabulary,
Stage 2 CDS, may have Document Imaging; HIE capable
48.8% 16.9%
Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 19.6% 7.2%
Stage 0 All Three Ancillaries Not Installed 18.4% 11.5%
Source: HIMSS AnalyticsTM Database N = 3,816/5,235

5. Expectations, Limits, and Barriers
for EMRs/EPRs in Canada
• Expectations:
• Widespread adoption of physician/primary care clinic EMRs
• Obligation to make minimal data available to all patients –
lab/radiology diagnostic results, drug history
• Minimizing number of EMR platforms in most provinces
• Limits:
• Full acute care implementations at a few selected sites
• Extensive rural environment precludes practicality of complete
paperless EMRs in most population centers.

6. Expectations, Limits, and Barriers
for EMRs/EPRs in Canada
• Barriers:
• Clinician adoption remains a challenge
• Canada has yet to adopt HL7 CCD standards
• EMR strategies remain intra-provincial
• Emphasis by Canada Health Infoway on pan-Canadian
PHR
• Economic restrictions due to large deficits

7. 2009 Canadian/U.S. Comparison
CDN US
Final Final
Complete EMR; CCD transactions to share data; Data
Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7%
Physician documentation (structured templates), full
Stage 6 CDSS (variance & compliance), full R-PACS 0.2% 1.6%
Stage 5 Closed loop medication administration 0.0% 3.8%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 1.1% 7.4%
Nursing/clinical documentation (flow sheets), CDSS
Stage 3 (error checking), PACS available outside Radiology
28.8% 50.9%
CDR, Controlled Medical Vocabulary,
Stage 2 CDS, may have Document Imaging; HIE capable
22.7% 16.9%
Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 11.7% 7.2%
Stage 0 All Three Ancillaries Not Installed 35.6% 11.5%
Source: HIMSS AnalyticsTM Database N = 660/5,235

8. IT Spending in U.S. hospitals
• Projected 2009
spending:
• $27.5B -
$30.41B
• Actual 2009
spending:
• $28.03B

9. Thank you!