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a t O r e g o n H e a l t h & Science University. "They may [a lso] work in nursing homes or menta l hea lth a reas." A sh says cost is likely prohibitive for those who don't use EHRs, but she is skeptica l that a generation gap between older and younger clinicians plays a role. " I 'm s u r e c o s t i s a n i s s u e , b u t I don't thin k a ge is a n issue," she says. " Ma ny st ud ies have show n t hat a ge [isn't a factor in non-adoption]. In my own resea rch, it ha sn't been a n issue. Younger providers get frustrated when the EHR does not have a ll the bells a nd whistles, just like older prov iders get frustrated by clunky technolog y — the frustrations a re equa l." IMPETUS FOR IMPLEMENTATION E x p e r t s a g r e e t h a t a h e a l t h c a r e la ndscape w it h patchwork EH R use ha mpers ef f iciency a nd infor mation sha r ing a mong prov iders, a s wel l a s t he la rge-sca le data a na lysis neces- sa r y for genetics-based persona lized medicine. Emerging developments may g ive the push towa rd universa l EHR adoption fresh life. In January, Centers for Medicare & Medicaid Services (CMS) Act i n g A d m i n i st rat or A ndy Slav it t announced the MU program will likely end this year. Yaraghi believes the end of the prog ra m could spur EHR non- adopters to action, and new factors could begin to drive adoption. He thinks one such driver will be vendors' turning to non-adopters as a kind of fi na l frontier. " Li ke a ny ot her business, vendors go a f ter easier, more prof itable ta rgets f i r s t ," Ya r a g h i say s . " T h at i s , l a r ge hospita l systems that need expensive EHRs. Now that a lmost a ll of them have a lready adopted EHR s, vendors need to f ind new customers. The on ly pa r t of the ma rket that still hasn't adopted i s t h e s m a l l pr a c t i c e s a n d of f i c e - based physicia ns." A nother factor that will drive adop- tion, Ya raghi says, is the trend of la rge ho s pit a l s a n d pr a c t i c e s a c q u i r i n g sma ller hospita ls and physician groups. T h i s a l r e a d y s e em s t o b e a t work : According to t he Black Book sur vey, 88 percent of new EH R adoptions in 2015 resulted from acquisitions. Still another reason EHR non-adopt- ers may be more li kely to implement digita l systems in the future, according t o Ya ra g h i , is a f u nda ment a l t ra n s- for m at ion i n what EH R s ca n do for them. If clinicians are able to use EHRs for a n a ly z i n g d at a rat her t h a n ju s t a rch iv i n g i n for mat ion , t he s ystem s will bring them g reater va lue, he says. "An example is [CMS'] Chronic Care Ma nagement, which pays physicia ns to follow up with their patients who have more than one chronic condition," Yaraghi says. "EHRs allow physicians to ea si ly identif y such patients a nd get reimbursed a n additiona l fee for minor additional e ort. This will drive physicians to adopt EHRs to increase their revenue. Data analy tics can also help physicians make better decisions easier, which makes them happier and will drive them to adopt EHRs to enjoy such benefi ts." D ou g l a s B r ow n , C o -fou nder a nd President of Black Book, expects ma ny la rger, wea lthier physicia n g roups to adopt a na ly tics-capable EHR s during the next two years. New or replacement adopters with less money to spend will likely turn to low-cost cloud EHR s. " The biggest leap in adoption will be from physicia ns who wa nt sma r tphone access to patient data," Brown says. "Not a ll EHRs are prepared for this. The EHR vendors with mobile applications will g rab these adopters." ■ M D N E W S . C O M /// M D N E W S C EN T R A L N E W YO R K ■ 2 016 2 1