The following was a comment made on my previous post about Meaningful Use attestation issues by Jon (man there are a lot of John/Jon’s in Health IT). As always, I do my best to bring out interesting topics for all to read. In this rant, Jon makes some interesting comments about the challenge of specialty EHR software to meet the MU measures. Something I’ve mentioned before, but Jon adds some more insight.
It is even worse for some small EHR vendors that have existed for over 20 years – like the one I work for. The government has no idea how ugly and not applicable many key elements of meaningful use (defined as the government chooses) are for non-primary care, highly specialized providers.
Here’s a conundrum that frames EHR certification and meaningful use in a way I rarely see it discussed (and would love for someone to explore more *hint hint*) – take a small, but established vendor of EHR software which is not yet certified.
This vendor provides software to a niche industry of highly specialized providers, who do not derive any real or identifiable value from meaningful use as it is defined (to keep things generic I will omit the specific part of the industry).
To get software 100% EHR certified you must fulfill all of the requirements, even if, as a vendor, your customers will not make use of, or benefit from, most of the functionality. Please take as an assumption (for this discussion) that only 30-40% of the EHR certification requirements are of value to the customer.
Since the customer will not make use of the functionality, they don’t want really want to pay for a 100% EHR certified product. But they sure would like the incentive money (or in the case of Medicare providers, will get penalized if they didn’t do meaningful use).
As a small vendor, your big competitors are all EHR certified (and some are even free), but even if it didn’t make sense for the customer – because the other (typically larger) vendor can afford to implement it, even if it is sloppy. Customers see a well-known product name from a large company is EHR certified – so EHR certification gives those who complete it an edge – even if it makes zero financial or functional sense.
I hate being a pessimist, as surely some good has come from meaningful use. However, as we are seeing by these posts, what value does EHR certification and meaningful use TRULY bring to the provider, other than the requisite piece of paper to get incentive money? We need to see many, many more successes, and in my specific case, we need to make sense of how to make something which is not useful… useful somehow.
Sure, the answer to this might be that in the long run, vendors with better or more applicable products will always win out, but we know that this isn’t always true based on long-term software contracts or lack of desire to switch vendors. Or the answer might be that highly specialized providers only account for 20% or less, and 80% of the provider population is primary care or similar handle meaningful use just fine. Or maybe that I’m just crying in my beer!
Nevertheless, we have this catch-22.. or an enigma wrapped in a mystery shrouded in a riddle.
*end rant* Comments? Thoughts?
One other note from John Lynn, I’m sure many large EHR vendors will probably say that if small EHR vendors can’t meet the MU requirements, then they don’t deserve to be an EHR software. Those that say this, are really missing the point. It’s not that they couldn’t meet the MU requirements, it’s a question of should they meet them in MU’s current state.