Two decades ago, a technological wave influenced healthcare IT, and fundamentally changed the role of CIOs. This wave—the advent of Electronic Health Records—brought with it a new paradigm, creating new CMIO positions as well as an ever-growing team of analysts, managers, directors, and VPs to help implement and support EHR systems. The expectations of CIOs rapidly evolved from the management of health information to directly supporting clinical transformation within health systems. Despite concerns related to lack of interoperability, decreasing provider productivity, and suboptimal user experience, there has been a huge investment in delivering EHR, with the $28 billion federal investment in health IT and the passing of the HITECH Act being key to incentivizing adoption.
While EHR interoperability has certainly improved, it fundamentally remains a transactional, provider-centric, record keeping system designed for the era of Fee-for-Service (FFS). Given soaring healthcare costs, significant variations in management, poor quality outcomes, and an increasing fragmentation of care, healthcare is shifting towards pay-for-performance (P4P), the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). This large-scale transformation towards value-based healthcare has unveiled a crucial limit to EHRs—that of enabling longitudinal care. The inability of EHRs to meet value-based requirements is, therefore, helping to shape a new technological wave of Health IT: The wave of patient-centered digital medicine technologies.
In 2003, the Institute of Medicine (IOM) settled on the name Electronic Health Record to help direct the computerization of medical records towards improving the overall safety and quality of care for patients; not just to replace paper medical records. This, along with FFS shaped the EHRs we see today that were developed using a plethora of disjointed lab information systems, billing systems, and result reviewing systems.