Written by: John Lynn
The following is a guest blog post by Karen Knecht in response to the question I posed in my “State of the Meaningful Use” call to action.
If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?
Chief Innovation Officer at Encore Health Resources
It’s an interesting question you’ve posed on MU, and I think you have generated some great discussion on this topic, such as last week’s response by Dr. Sherling from the perspective of an eligible provider.
My colleagues and I would like to provide an eligible hospital perspective. The industry is now three-plus years down the path of implementing “certified EHRs.” There was a need to kick-start the digitization of healthcare in this country and create a common infrastructure to drive change, and MU has done that. For example, establishing standards for data capture is critical for unified reporting and analysis. Would the industry establish and adopt these standards without a program like MU?
But working with many large healthcare organizations representing several hundred individual hospitals in their MU programs, there are clearly many lessons learned and opportunities to improve for the future, even if the MU program were to go away.
Overall, there are no MU objectives that we would discount as having no value. However, there are some that have served their time and others that are ahead of their time.
For the parts to continue, we see a high level of value in the CPOE, Barcoded Medication Administration, Medication Reconciliation and Clinical Decision Support objectives, as they are making tangible contributions to patient care. However, we would recommend timeline delay due to additional capital outlay as well as complexity of workflow. This would give more time for deeper and broader adoption.
For the parts to no longer measure in the same way, we would start by simplifying and removing the objectives that are topped out: the ones that are already hardwired in most organizations such as Vital Signs, Demographics, and Smoking Status. This is no different than the current process for removing quality measures from reporting requirements once they have been well adopted — and HITPC is in agreement about this. In their meeting last week where they discussed proposed Stage 3 measures, they were saying much the same thing. Even if you stop measuring these things explicitly, they will continue to be electronically documented.
Second, we could see removing objectives that are now standard for “certified” EHRs. For example, the time and effort to document the Drug Formulary, Drug-Drug, and Drug-Allergy checking functionality, for the sole purpose of meeting the MU objective, is not well spent. Another example is the lab results stored as discrete values, which are part and parcel of any lab system in existence.
Other objectives that are causing great concern among many hospitals are the ones dealing with providing and exchanging information electronically. It would be helpful to reconsider the expectations for these objectives, since many are finding out that implementing a patient portal without a sound patient engagement strategy is not going to be enough to ensure that 5% of patients will actually access their records. Hospitals should have a portal and secure messaging capability, but it doesn’t seem realistic to put thresholds on patient utilization. As the old saying goes, “You can lead a horse to water, but you can’t make it drink.”
Additionally, the requirement for Direct exchange to transmit summary of care is cumbersome and actually a step backwards for those entities who are part of an HIE and are currently exchanging data among members. For most others, it is really only practical to implement with a physician ambulatory partner. The sad fact is that nursing homes, SNF’s, and other entities where hospitals commonly transfer patients are not included in the EHR incentive program and do not have the technology necessary to participate in a direct exchange in a meaningful way.
And finally, we think all aspects of electronic quality measures should be rethought. We love the idea of calculating these measures electronically, but they need to be appropriately validated and re-addressed in the context of the poor data collection that is occurring. Perhaps CMS should consider another voluntary incentive program for facilities that have fully implemented all their clinical documentation. Given the change that is proposed to the physician quality reporting programs as a result of the SGR fix, perhaps a similar refinement of the IQR and VBP programs along with MU should be considered.