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Leveraging Health Information Technology for Accountable Care: Thoughts From the Field
Yunfeng Shi, PhD; Dennis P. Scanlon, PhD; and Alejandro Amill-Rosario, MPH
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Leveraging Health Information Technology for Accountable Care: Thoughts From the Field

Yunfeng Shi, PhD; Dennis P. Scanlon, PhD; and Alejandro Amill-Rosario, MPH
The authors discuss health information technology in the context of health systems, the potential harm of electronic health record vendor consolidation, and overcoming barriers in providers’ experience.
The ongoing focus on interoperability, along with provider consolidations, may have contributed to the increasing trend of concentration in the EHR market. Based on the American Hospital Association’s Annual Survey and IT Supplement (2012-2016), a recent analysis reported that 35% of the hospitals switched to the EHR vendor of the acquiring health system within 3 years of consolidation (the proportion is likely to be higher after 3 years), whereas another 21% had the same EHR vendor before the consolidation.11 Interoperability has become a key determinant in EHR vendor choices10 and is likely to be further prioritized as PI progresses to the next stage. Health information can often be exchanged more efficiently (or more easily) among EHR platforms from the same vendor. Hence, it is not surprising to see health systems and providers converging to a concentrated set of vendors. Moreover, to protect or to further increase market shares through competitive advantages, current leading EHR vendors may even strategically create barriers to information exchange with competing products, so that new adopters (or switchers) will be somewhat “forced” to choose the vendors that currently dominate the market.12 Reduced competition may also negatively affect the innovation, quality, and pricing of EHR products in general. In light of this, PI may need to be paired with regulatory (eg, data standards that encourage information exchange among different platforms) or incentive (eg, penalties for vendors that do not facilitate data sharing with competing platforms) policies to maintain a competitive EHR vendor market.

Overcoming Barriers to Better Health IT Experience for Providers

The ONC report outlined major barriers “associated with health IT capabilities and data sharing” (eg, financial and trust barriers) and those “associated with health care providers’ experience with health IT” (eg, barriers related to documentation and usability).3 In particular, “lack of alignment with real-world clinical workflows” was mentioned among the usability issues.3 These barriers, many of which can be conceptually linked to the technology acceptance model13 and the resource-based theory,14 lead to frustration and lower the value of health IT as perceived by providers. The lack of interoperability is an important source of provider frustration in using EHRs,15 which in turn contributes to physician burnout.16 However, a recent study also found that the integration of ambulatory and hospital EHR systems, often an important step to improve interoperability, may decrease provider and patient satisfaction, partly due to the resulting changes in work processes.17

These findings suggest the complex and multifaceted nature of provider experience with EHRs. At the root of the problem may be the competing demand for customization and standardization at the same time. Population-based longitudinal studies are needed to help us better understand the prevalence and trends of specific barriers among providers (eg, workflow changes or disruptive alerts), based on their actual experiences in using EHRs. Our empirical knowledge regarding barriers to effectively using health IT is particularly limited in ambulatory care. The success of PI relies on overcoming (or at least mitigating) some of these barriers. Coordinated efforts from health systems, frontline users, vendors, and policy makers are needed.


Health IT needs to be examined in the context of health systems’ increasing role in care integration and delivery. How to promote interoperability while maintaining the competitiveness of the EHR vendor market is an important policy question to be addressed. Overcoming major barriers and improving provider experience with health IT is a key element to the success of achieving value and accountable care.

Author Affiliations: Department of Health Policy and Administration, The Pennsylvania State University (YS, DPS, AA-R), University Park, PA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (YS, DPS, AA-R); analysis and interpretation of data (YS); drafting of the manuscript (YS, DPS); critical revision of the manuscript for important intellectual content (YS, DPS, AA-R); administrative, technical, or logistic support (AA-R); and supervision (YS).

Send Correspondence to: Yunfeng Shi, PhD, The Pennsylvania State University, 504 Ford Bldg, University Park, PA 16802. Email:

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