The new National Coordinator of Health IT, Karen Desalvo, MD, published a blog post on The Health Care blog that proclaims that the “EHR Incentive Program Is on Track.” Of course, many would argue that it’s her job to be a cheerleader for healthcare IT, but I think this post is an important look at the measures that ONC and HHS have of what they consider a success.
If the goal of the EHR incentive money is just to get doctors and hospitals using EHR software, then indeed it’s been a big success. EHR adoption is through the roof at every level (although, I think they’d like it higher in the ambulatory space). This can’t be argued. The $36 billion in EHR incentive money got healthcare on board with EHR software.
If EHR use is your measure of success, then the HITECH act was a success. However, the goal of the HITECH act wasn’t just EHR adoption. If it was, then we wouldn’t have meaningful use. The goal was for doctors to adopt an EHR and then meaningfully use it. Of course, the jury is still out on whether doctors will follow through on meaningful use stage 2. I’m personally predicting a major fall out from those who attested to MU stage 1 and those that choose to sit out MU stage 2. Certainly Dr. Desalvo argues that this won’t be the case.
Either way, let’s assume that the majority of doctors do attest to meaningful use stage 2. Should we call the HITECH act a success? More pointedly, does meaningful use produce the results we want?
As someone who follows the EHR industry day in and day out, I think the jury’s still out on this. I’ve said many times that I fear the EHR incentive money might have incentivized doctors to adopt the wrong EHR software. The current and future EHR switching will likely prove this out. Although, we’ll see if organizations can get it right the second time.
However, choosing the right EHR is only half of the battle. Even the best tool used inappropriately won’t yield the desired results. There’s a strong case to make that meaningful use forces a doctor to use an EHR inappropriately. Every person at ONC calls this blasphemous and every doctor is likely to agree that meaningful use causes more work and does little to improve care.
I recently heard someone argue that they had “no sympathy for doctors having to accurately, legibly, and cohesively document what is happening.” I think it’s a real challenge to say that meaningful use equates the more accurate, legible, and cohesive documentation. In fact, many of the meaningful use hoops serve to make the documentation more illegible and difficult to read. Not to mention the issue of making the physician less efficient and therefore more likely to cut corners.
In this post, I’m not trying to make the case for or against EHR software. I’ve done a whole series on the benefits of EHR and so I believe that they can provide an amazing benefit to healthcare when implemented properly. My point with this post is that if our government is going to spend $36 billion on EHR software, then I wish they’d spend a little more time making sure that it’s not only implemented, but implemented well.
If they did this, then maybe we could call the HITECH act a real success. As it stands now, we’re using the only metrics we have available: EHR incentive spent and meaningful use attestation. I’d suggest there’s so much more value (both gained and lost) in an EHR implementation than either of those two things measures.
How about we track ways EHR use reduced costs, improved patient care, and saved lives? Maybe they don’t want to track that data because if they do, they won’t like the results. What would they do with meaningful use if they found out it raised costs, hurt patient care and did nothing to save lives? Would anyone want to make the case for why meaningful use should be scraped for something better? I wouldn’t want to as the new ONC chair either.
I don’t see any claims of success in that post, just a claim of movement.
In the world of bureaucracy, movement seems to be all that really matters compared to actual success or improvement to operations.
I’m all for EHRs…I just think the government went about this all wrong.
Imagine for a moment how advanced VistA would be if the government had said: “You must be on an EHR by X date. You can either buy your own, or use this open source EHR we have developed.”
No incentive money would have meant, no meaningful use requirements.
There would have been a similar period of painful growth as VistA was tweaked/modified/improved, but in the end I think it would be a solid system…AND…all those on Vista would be using the same data structure!
Maybe you did mean, “rough”.
Or is this a test to see if we actually read the article? 🙂
I still wish they’d scraped MU completely and just focused on interoperability. If they’d used the incentive to establish a standard for interoperability and paid doctors who used it, we’d still have EHR adoption and we’d have shared patient records which could really impact healthcare for good without all the MU overhead.
Good catch AXEO MED. Fixed. Thanks for actually reading the article;-)
We would get EHR adoption IF EHRs actually made offices efficient.
$$$$ is the incentive, yet giving out $$ shouldn’t be the incentive, it should be the ability to save $$ with efficiencies from an EHR…and those efficiencies just don’t happen.
One could argue this is not unlike the cash for clunkers program. Give people “cash” to buy a new car – also known as creating false demand. Once the cash dries up, so does the demand, and things get out of whack.
The EHR market is currently out of whack for similar reasons.
Another good post John. As someone from the trenches, I do see practices embracing EHR and using it in a meaningful way – although they initially started using it to meet the MU II requirements.
Could ONC have come up with inter-operability earlier along with MU I; they could have but the constituents in healthcare were not ready for many elements of inter-operability and communication protocols; and some of the standards such as DIRECT etc were finalized after MU I was in vogue.
In any event, MU I has been a building block in adoption of Health IT; and similarly MU II (with all its flaws) will also strive to take healthcare that much closer to digital world.
Was ONC’s efforts successful? From the trenches, in surely seems so.
It seems to be that maybe success has to be measured in stages. Until you have some reasonable level of adoption you don’t have the data to measure the outcomes.
You don’t know your breaks don’t work until you get the car running.
I just hope the government learns from its mistakes. Stage 2 is showing the large cracks and will crumble and Stage 3 is a lost cause. Healthy? Absurd. Hardly 10% of EMR companies are certified for MU2. Now that the MU program is dwindling in its “bonus” there is really no incentive for EMR companies to stay in the game, especially when the MU core measures are hurdles that essentially no one can attain. Its great that many primary care MDs have at least a basic EMR now. There is no chance for interoperability, or MU 2 or 3. MU 1 Providers will expect efficiency now, and that is the EXACT opposite direction they are headed. No one wants to beg patients to use a portal or pretend to some how log into an HIE, or chew through 14 Core measures, etc. No one has time for that. With ACA, many older providers will just give up and exit this whole game, which adds MORE time constraints and pressure on efficiency. There is no Core measure for efficiency. That should have been the goal from the beginning. There were so many technical mistakes with this MU program. From the beginning with MU1, silly things like focusing whether race was clicked, is crazy. Typical government bologna of “meaningful use” sucked the life right out of this. NO one thought completely through this process. Everyone just added more layers to make it a tad challenging to get some “free” money for EMR. All wrong. Very simple things needed to happen from the beginning to make this work. For instance, there is NOT a chance that you can have interoperability without a unique patient identifier. Database 101. Its just too easy to mess up databases that do not have unique IDs. No matter how hard you try, every “John Smith” in this country is in trouble with interoperability. Secondly, if the government REALLY wanted interoperability it should have rolled the political dice and told every provider that there will be ONE central data storage that everyone’s health info with appropriate security measures, can access. One US HIE. Secure monitored locked down. Not hundreds. Patients want to access their information in ONE location. If I make a report/office note/etc. I have to post the report in the ONE national HIE. If a mistake is made, it is fixed ONCE. Now, if a mistaken report, wrong side, site, or patient gets propagated forever. If you had just one HIE, people could find EVERY image, report, lab, path report, etc. The way it is now, there really is NO chance for any of this to work. How do I access a competing hospital’s images to view (and not repeat)? No HIE does that. Do you know how many patients ask me if I can just look up the images at some other hospital? Like I have access? If I break a leg in Indiana and go over the border to Ohio, there is NO way to access the records from Indiana, especially the images, etc. Has anyone REALLY ever used an HIE for information? I should say any real provider? Mark my words this is a mess, and Karen Desalvo just latched her political career on a sinking ship. With NON honest assessments, from the government leaders, history repeats itself over and over. Once they realize at the end of this year with the impending ICD-10 disaster (bad data in bad data out), and all the other programs hitting, including the “Forget about MU2” looming, the perfect storm will wreak havoc. I just hope there is some real political will to reassess and redirect and reprogram.
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I hope all their doctors are aware of the risk of getting a free EHR. I wonder how they would react to this news. http://www.forbes.com/sites/kashmirhill/2013/10/24/practice-fusion-reviews-whoops/
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