Health IT improves with financial rewards healthcare professionals

In recent years, American hospitals have significantly improved their IT systems. Their average score in the Electronic Medical Record Adoption Model (EMRAM) increased from 2.8 in 2009 to 4.4 at the end of 2015. This enormous improvement in American Health IT can be ascribed to the Meaningful Use programme created by the American government. This five year programme (2011-2016) rewards hospitals that digitise their records. I hope that government and health insurance companies in the Netherlands will also launch a Meaningful Use programme, because small financial nudges are effective. That is what behavioural economics teaches us in theory and the American healthcare system teaches us in practice.


This improvement in America’s EMRAM-score is caused by the fact that hospitals have digitised their nursing records and merged them with their medical records. They have also embedded many more decision support systems in their IT systems. Management reports have improved. Patients have been given the option of consulting their own electronic records and contacting doctors and nurses online. Pharmacovigilance has also improved thanks to the use of barcodes and additional checks between the prescription and delivery of medication.


An EMRAM-score expresses the degree of digitisation in a certain hospital. When a hospital scores zero, all data is recorded on paper. At a score of seven, the hospital is completely digitised. John Hoyte was the one who observed both this spectacular increase in the American EMRAM-score and the way this development appeared to be linked with the Meaningful Use programme. Hoyte is the director of Himms, the organisation that records the EMRAM-scores of thousands of hospitals in America, Asia and Europe. At the end of January, he spoke at the Cocir conference in Brussels, which dealt with chain care and IT. He and I gave lectures, about health IT and chain care from an international perspective.


American hospitals that participated in the Meaningful Use programme received a financial reward of 21,250 dollar per specialist in the first year. In the following years, they received 8,500 dollars per specialist. For a hospital with a hundred specialists this means more than 2 million dollars worth of extra income in the first year and 850,000 dollar in subsequent years. Only hospitals with a multiannual health IT plan were eligible for the Meaningful Use programme.

Behavioural economics

The sums that are paid through the Meaningful Use programme are low compared to hospital budgets that often comprise hundreds of millions of dollars. The fact that these low amounts have resulted in such significant, positive effects proves that behavioural economics work. This new professional field uses small financial nudges with a large psychological impact. The Meaningful Use programme is one of the government’s showpieces and generates a lot of publicity. Hospital directors could therefore not afford to ignore the programme and participated en masse.

The Netherlands

Dutch healthcare would also benefit from improvements in Health IT. I would therefore like to encourage the government and health insurance companies in our country to also initiate a similar Meaningful Use programme, including small financial nudges. Not just for hospitals, but for all healthcare providers.

What do you think? Do you think a programme like that would also work in the Netherlands? Post your reactions below!

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