As I said in my previous EMR and Health IT in 2012 post, I’m going to create some of my own lists for 2012. I decided to tackle the first one on the list: My 2012 EMR and Health IT Wish List. This was kind of fun to think about. I’m also sure that I’ll come up with other ideas once this is posted, so don’t be surprised if I add things to this list in a future post.
I should also note that I’m not sure any of these things are going to happen in 2012. In fact, I bet that many of them aren’t, but this list isn’t about what is going to happen. This list is about what I wish would happen.
EHR Companies Would Embrace Interoperability – It’s an incredible shame that in 2012 we still don’t have interoperable health records. EHR companies need to get off the stump and make this a reality. The technology is already there and has been there for a while. EHR companies need to start making this dead simple because it’s the right thing to do. Sometimes doing the right thing is more important than the bottom line. Plus, doing the right thing ends up often being the best long term strategy for your bottom line as well.
Start doing what’s right and making your EHR interoperable!
Meaningful Use Would Go Away – I’m actually certain that this one won’t be happening in 2012, but I wish it would. I guess there’s a small chance that it could go away if Republicans take control of Washington and start slashing everything Obama related. However, I have a feeling that even then meaningful use will find its way back into Washington. There’s too much invested in it.
My reasoning for wanting meaningful use gone is clear. It provides a perverse incentive to providers and often incentivizes them to choose an EHR software that doesn’t work well for their practice. As I’ve mentioned in some recent posts, far too many clinics are so focused on meaningful use and EHR incentive money that they’re ignoring the real and tangible business cases for implementing an EHR in their clinic. I think this is a bad thing for healthcare and EHR software in general. The short term bump in EHR adoption won’t be worth the cost of EHR implementations focused on the wrong criteria.
I also really hate how meaningful use has hijacked the software development cycle of pretty much every EHR vendor out there. This is a real travesty since rather than developing for user/customer requirements EHR vendors are developing for a criteria. Talk about a perfect method for destroying innovation. This is a real travesty in my opinion.
Of course, I’m a realist and realize that meaningful use isn’t going away. We have to make the most with what we’re given and live with the realities that exist. However, in this New Year Wish list, I wish that meaningful use would be a past memory.
New Healthcare Model that Provides Care, Not Reimbursement – I’m sure many of you might be thinking that I’m calling for ACO’s in this wish list item. We’ll see how ACO’s evolve, but my gut tells me that the ACO model still won’t make the fundamental change that I wish would happen in healthcare. There’s far too much focus on reimbursement the way our healthcare is structured today. I’m not arguing that doctors and other healthcare professionals not get paid what they deserve. I’m just wishing that there was more focus on care for patients and less worry on maximizing the reimbursement.
How does this have to do with health IT and EHR? I’ve long argued that the biggest bane to EHR systems is the onerous reimbursement requirements. I can’t imagine how much healthcare could benefit from fabulous EHR systems if the energy spent on maximizing reimbursement were spent on improving patient care.
Diabetes Prevention App – I’ll admit that this is a little personal. I come from a long line of diabetes in the genes and I love sweets far too much. I’m pretty much destine to be a diabetic. I think that mHealth apps can have amazing power if done correctly. My wish is for someone to create a Diabetes app that will help me overcome the seeming destiny I have in this regard. The key will probably be illustrating in a profound way the impact of the choices I’m making.
Of course, you could insert hundreds of other chronic illnesses into this wish list too. I’d love to see mobile health work to solve those as well.
A True Patient Identifier – I realize that America is a large place, but we’re also a really creative country that can figure out creative solutions to problems. The lack of a true patient identifier is a challenge and a problem in healthcare. I’d love to see this problem finally resolved. I think every EHR company would rejoice at this as well.
Real EMR Differentiation – My heart absolutely goes out to doctors, practice managers and others who have the unenviable job of trying to sift through the 300+ EMR companies. I’d love for some EMR companies to really do something so innovative to differentiate themselves from the rest of the pack.
No doubt part of this problem is what I stated above about meaningful use. Hard to create innovation and differentiation in EHR when you have to develop for a government list of requirements.
EHR Data Liberation – I’ve wanted EHR data Liberation for a long time, but I think in 2012 this is one thing on the list that could become a reality. It’s a bit of a long shot, but I think there’s potential for this to happen.
My gut tells me that if we can find a way to liberate the data that’s stored in EHR software, then we’d see a dramatic increase in adoption of EHR. One of the major concerns doctors have with selecting an EHR is that once they select an EHR they know they’re locked in with that EHR for the long run. If a doctor knew that they could switch EHR software if they made a bad choice, then they’d be much more likely to pull the trigger on EHR adoption.
We need a wave of EHR vendors that aren’t afraid of liberating their EHR data, because they:
1. Know that their EHR software is so good users won’t leave
2. Know that if someone wants to leave their EHR software it’s better that they find one that’s good for them than the few extra dollars the EHR company will make off an unhappy user.
How’s that for a wish list? I think achieving these things would do an amazing amount of good in healthcare and EHR. Of course, I won’t be holding my breathe on any of them happening any time soon. That doesn’t mean I won’t keep holding out hope.
Interoperability: I agree 100%. In all other industries there are public APIs, etc. Interfaces held hostage by the individual vensors are one of the main anchors on REAL progress in HIT.
As long as CMS is incentivizing the EHR companies to not be interoperable, it’s not going to happen, right thing or not. They can walk in now, point to the fat MU check and tell the hospital that it behooves them to rip their current systems out and put in a suite that plays nicely together. And you’re right, it’s the biggest reason MU should go away. EHR’s are being selected by CFOs, not clinicians.
Data liberation definitely needs to happen. Doctors need to be able to retain their own data, especially if they want to switch to another EMR. The data should belong strictly to the practice and not to the EMR vendor.
@Sarah, when the weaker EHR startups start inevitably falling by the wayside, a lot of data migration people are going to make a lot of money. And I’m definitely not saying that’s a good thing.
Sarah,
I’m thinking about putting together an initiative for EMR companies to join in regards to EMR data liberation. If I do it right, it will get a lot of exposure for the EMR companies that participate and liberate their EMR data. Want to be part of it?
John,
In regards to merging ONC-sponsored standards incentivizing EHR companies to embrace interoperability see: http:wiki.siframework.org and http://news.avancehealth.com/2011/05/emerging-standards-and-disruption-of.html and http://www.nationalehealth.org/ckfinder/userfiles/files/S&I%20PowerPoint.pd
In regards to EHR brand differentiation, it’s getting harder every day. As you can see at: http://onc-chpl.force/ehrcert, there are now 1,556 ONC-certified ambulatory and inpatient EHR products available to doctors and hospitals (it’s already a $15.6 billion market), an increase from 822 products on June 20, 2011, or a 53% increase in the last six months.
Dr. Coli,
Yes, ONC has put in some serious effort on their side to try and create a standard and to drive interoperability. However, they have limited tools at their disposal. They need buy in from the EHR vendors or it will just be fluff.
ONC-ATCB certification has brought zero differentiation of EHR products. In fact, if anything it’s created a myth that all EHR software is the same.
[…] I guess what I’m saying is that I don’t expect doctors to willfully misuse the information, but I do believe that accidental mistakes can happen. For this reason, I believe we have to start thinking in terms of a Patient ID, which will not only be useful for things like advanced directives, but also for ease of identification and data portability. It makes sense why John wants a True Patient Identifier. […]
John,
I had a lengthy missive almost ready to post, but it got wiped out, as happens when another post is entered. So I’ll repeat just the last item…
Wrt Diabetes, you don’t need a “Prevention App”. (I too am “pre-diabetic”.) You just need to… 1) Ignore much of main-stream medical advice on the subject — FDA, USDA, AMA, ADA, etc. 2) Lose excess weight, and do this by minimizing carbs and sugars. It doesn’t matter whether the carbs come from Wonder Bread or from the finest multi-grain — carbs are carbs and convert to the sugars your pre-diabetic body does not need. 3) Eat plenty of animal products — especially saturated fats, which provide the enzymes your body needs and ironically help to remove that spare tire around the middle. 4) Refrain from soy products and polyunsaturated fats [as much as possible] — both are deadly over time. 5) Don’t treat “high cholesterol”, unless the total exceeds 300 (not 200), and don’t take statins. 5) Insist that your PCP (who btw is not trained in preventive medicine) request a test for A1C. As long as this 90-day-average blood sugar measurement is below 6.0, you’re fine. 6) Educate yourself on this topic — you’ll likely know more than your doctor does.
Sorry if I’ve offended any docs who read this post. Counter-advice welcome.
David,
If you hit back your comment should be there.
Your list sounds like it would work. The problem is that reading your list I’m not motivated to do it. I’m hoping an app will come around that will find ways to educate me on items like the ones you mention and find ways to encourage me to do them (game mechanics or otherwise). If I knew all the secrets to motivating people this way I’d be building the app. My prediction is that someone will do it.
Reminds me a bit of most diet programs. Almost all of them center around portion control and exercise. They’ve just created interesting ways to get you to do those 2 things consistently.
John:
100% right. Buy-in is needed from the vendors — and there is no incentive for them. In fact, there is an anti-incentive — they will lose the $25k, $50k, etc. per interface that the industry is forced to pay.
John … w/o interoperability no other HIT item is possible. Interoperability standards is the domain of industry.
ONC will simply screw it up and their involvement guarrantees that interoperabilty … and therefore the balance of your HIT list fails.
Would love to see how long we could keep MU out of the daily conversation for all the reasons you and others have noted. We need to let the practioners define what is meaningful to their abilty to improve their practice and patient clinical outcomes effectively. All the ONC and ATCB hoopla to screen products down to 1556 ambulatory and inpatient suitable boxes reinforces how really stupid this idea really is.
So … we have totally wasted three years now haven’t we?
Don B,
I wouldn’t say the last 3 years are a total waste. I might be able to argue that the government spending on EHR has been though.
Great list John, while the discussion is largely about interoperability I would just like to say that I wish you could have seen the single tear that rolled down my cheek when I read about hijacked EHR development cycles.
Andrew Cox,
That single tear is representative of the thousands of tears doctors will shed thanks to that lost cycle.
“I guess there’s a small chance that it could go away if Republicans take control of Washington and start slashing everything Obama related.”
__
HHS is figuratively loading bundles of cash on palettes and driving them out the doors with forklifts (a la Iraq) to get funds “obligated.”
But, any large scale PPACA and HITECH cuts won’t ensue until 2013 in any event, even assuming GOP control of Congress in the wake of the next election.
Your comments about Meaningful Use make sense to me as an expression of regret that a field that should be full of constructive risk taking has ended up being driven forward by a government agenda. However, the fact that such a simple program could have such a massive effect on vendor product development shows how little inherent self direction the field possesses on its own. If a government threatened with bankruptcy due to health care costs induces the industry to move in one direction, a direction that could help contain costs, who can blame them? Well, you do, which I have never understood.
Charles,
Some interesting observations and I’m glad you have a different view. Here’s some thoughts in response.
First, I personally wouldn’t call meaningful use a simple program and $36 billion in EHR stimulus for a market that’s projected to be $8.3 billion in 2016 (see http://www.emrthoughts.com/2011/12/12/emr-market-8-3-billion-by-2016/) isn’t a small program either.
I agree with you that it’s unfortunate that the vendor community lacks self direction to be easily swayed. Although, it’s hard to argue with their decision based on the request the doctors are making for them to be compliant so they can get government money.
Yes, a move in one direction could help contain costs. Although, it could also end up increasing costs if they incentivize the wrong EHR software and then sets back broad EHR adoption more than if they’d offered the EHR stimulus. This is why I blame them. I certainly wouldn’t if I saw a better outcome on the program.
I hope I’m wrong and the costs are contained through massive adoption of EHR software.
@Matt,
I think data migration companies are not going to grow, but EHR vendors will have to provide data migration for “switchers” in order to close the deal.