Shifting Motivations: Rethinking Primary Care Physician Incentives In Health IT Implementation

Clinician adoption and implementation of health information technology (IT) has increased significantly since the passage of the HITECH Act in 2009. Dedicated efforts and large financial incentives have spurred innovation and motivated progress in many aspects of information technology, including information exchange and community-level health IT implementation. Yet poor usability of systems and overwhelming reporting burden still present barriers to optimal use of health IT.

Health IT capabilities — such as automated performance feedback; shared documentation with patients; population health tools; and clinical decision support, facilitating evidence-based health care — can potentially drastically improve quality of care, particularly in primary care practices. However, the current incentive and payment structures are not aligned with productive use and spread of health IT innovation. When many primary care physicians use electronic health records (EHRs), the problems they are now tasked to solve relate to billing and coding compliance and to achieving “meaningful use” through the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Programs; many clinicians and systems are not encountering or using EHRs as productive clinical tools.

Perhaps the focus of providers and health systems on meeting the technical and administrative requirements of “meaningful use” has obscured the creative opportunity for clinicians to explore how to use EHRs to improve care, and to see their own actions as part of the solution to effective implementation. Strategies that focus on creating space for discovering ways that IT can support effective health care — e.g., more flexible payment models with emphasis on population health outcomes — may be more successful than those that focus on health IT adoption.

Rethinking Physician Incentives

Policies that are most successful at driving health IT implementation toward improved outcomes may not necessarily be policies specifically focused on health IT. Approaches that afford physicians resources to implement health IT to support high quality, team-based care can free practices to design more effective systems to best serve their patients while improving provider satisfaction.

Outside of health care, organizations that have successfully implemented IT have relied on team-based approaches, empowered team members, and fostered innovation; improvements gained from technology were not necessarily captured with established metrics. All of these characteristics target the intrinsic motivation of employees to do excellent work irrespective of external incentives. If we are able to design policy in a way that encourages productive team-based care, leadership and innovation, we might better achieve the goal of improving care using health IT.

Ultimately, successful IT implementations rely on local innovation and creativity coupled with focused definition of the problem IT is trying to solve. Therefore, high-level policies specifically targeting EHR implementation may not be as successful as policies that help to change the local environment to encourage practice redesign that improves care at the patient and population levels.

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