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EHR Technology's Heuristic Adoption & Implementation Model

White Paper
December 30, 2015

When the U.S. Department of Health & Human Services created a program in 2009 to incentivize Electronic Health Record (EHR) adoption by the end of 2016, they didn’t account for a recurring problem: human beings.

The Centers for Medicare & Medicaid Services (CMS) program mandates three stages of “meaningful use.” Enticing users with incentive payments of up to $44,000 for Medicare Eligible Professionals (EP) and $2 million for hospitals, the ambitious program emboldened the daring and spurred the reluctant, but seven years later, it hasn’t inspired complete buy-in with all stakeholders.

A July 2015 study conducted by Physicians Practice found that of 1,181 respondents:

  • 68% said their EHR has not produced a return on investment.
  • 37% indicated they are seeing fewer patients after EHR implementation.
  • 37% of practices have yet to successfully attest to the Stage 1 rules of meaningful use.
  • 21% of respondents said their EHR vendor has yet to meet the Stage 2 certification rules (another 29% are unsure).

As with any development and adoption of new technology, even the most user-friendly interactive applications have no chance of broad user adoption without an overall social or cultural acceptance of the application. Well into Medicaid’s last year of payouts totaling $63,750 for each EP, patient portal software companies would have us believe that user growth is rampant, but the data show that isn’t the case. Stage 2 mandates establishing a patient portal, but…

  • 46% of respondents don’t have a patient portal.
  • 63% of practices that have a patient portal said that getting patients to sign up and use the portal is their biggest challenge.
  • 17% cited work flow related to difficulty maintaining communication between practice and patient. Busy nurses must remember to check the portal throughout the day.

When cultural buy-in fails to occur, the results widen the gap between cost vs. benefit, furthering reluctance in pursuing consistent efficiency at the expense of tried-and-true effectiveness.

Despite what amounts to a maximum 5% “tax” withheld from CMS-paid adoption incentive payments, the barriers to entry become just too insurmountable for many end-user medical practices due to various obstacles. But there is hope. Technology adoption can be increased when organizations take a systematic approach to implementation and include technology adoption campaigns are significant part of those implementations.

Less Is More

The price of technology adoption failures hits patients the hardest. Wait times go up and care is diminished. Frustrated doctors spend more time trifling with technology and tech support, and less time on compassionate patient care. In a November 2014 PWC interview, Ascension Health’s Michael McGarry understands the issue: “One thing we’re focused on is how to leverage technology to take us back to a time when there was a stronger (or maybe closer) physician and patient relationship, but with all the benefits of the modern world,” he revealed.

The healthcare industry is not alone in the pursuit of a better end-user experience. The road to technology systems integration and engineering has been paved by pioneers outside healthcare.

Encountering millions of initial users unfamiliar to his interface, Amazon founder Jeff Bezos noticed early on that the more time his employees spent assisting customers, the less time they could spend on empowering customers to help themselves. He told his executives that “Communication is a sign of dysfunction. It means people aren’t working together in a close, organic way. We should be trying to figure out a way for teams to communicate less with each other, not more.”

Trained people who are nearest to problems tend to be in the best position to solve them, for providers and patients.

In response to the Physicians Practice survey, medical practice consultant Rosemarie Nelson said that, “The key is to train the patient to learn that if they use the portal, they are going to get a response faster than if they call on the phone. That’s going to encourage them to use the portal more.”


As we wind-up the start of a new product life cycle – telehealth - providers are tasked with educating both their staff and the public about the benefits of EHR adoption.

As healthcare consumers are increasingly seen part of the solution to EHR adoption, technology will be developed and crafted around the user experience. Barriers to entry will steadily be removed. Advertisers will educate the market on solutions to cumbersome health portals, resulting in telehealth adoption going viral. It won’t be long before companies like Apple and Fitbit will feed UnityBPO’s integration continuum and impact the primary demand for better patient health outcomes.

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