Background: The HITECH Act promoted the use of electronic health records (EHRs) as part of the American Recovery and Reinvestment Act of 2009. Meaningful Use is an incentive program for providers to adopt EHRs. The MU program had built-in (and much debated) financial incentives and penalties. Requirements for MU include mandates and regulations regarding what must be in an EHR. These regulatory requirements and EHRs which were designed around them are what have led to overwhelming provider dissatisfaction with EHRs. An excellent music video on the subject describes this. Andy Slavitt, the acting CMS Administrator announced last month the end of Meaningful Use. This does not end government’s interest in health information technology, he suggests, but (hopefully) shifts focus from implementation to improvement. In a CMS Blog piece Slavitt elaborates:
“…For one, the focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients.
Second, providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them.
Third, one way to aid this is by leveling the technology playing field for start-ups and new entrants. We are requiring open APIs so the physician desktop can be opened up, moving away from the lock that early EHR decisions placed on physician organizations, to allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely.
And finally, we are deadly serious about interoperability. We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care. And technology companies that look for ways to practice “data blocking” in opposition to new regulations will find that it won’t be tolerated…”
I will describe five reasons why true ‘meaningful use’ of EHRs might take place because of the demise of the MU incentive program.
- The end of deadlines and incentives will hopefully signal the focus of IT on the patient. Meeting MU compliance deadlines has been one of the main priorities for CIOs. With this pressure gone, we can hopefully see their attention expanded to important issues like deployment of analytics for population health management and the adoption of mobile health technologies.
- EHRs will be designed for clinicians not administrators. The ability to have the EHR contain more relevant and easy to find clinical data instead of billing and other administrative data is what providers have been clamoring for. EHR vendors without MU requirements can easily create interfaces designed for the type of provider in mind (generalist, type of specialist) and even make the record reflect the individual clinician’s needs.
- Connected Health. Mr. Savitt mentioned opening up EHRs to connected health technologies. Personalized medicine can only occur if data specific to an individual (from biosensors, DNA analysis, and other patient-derived data) is able to find its way easily to the EHR. Heretofore this has been difficult for some and impossible for others, leaving patients and providers at the mercy of the EHR vendor. Opening the EHR to new technologies will go a long way to getting healthcare where many visionary patient advocates would like it to go.
- Real patient portals. The implementation of patient portals was part of Stage 2 of the Meaningful Use program. The MU participatory requirements for patient portal use were extremely low. In addition, the extent of a patient’s access to data is very limited. Patients deserve more access to their own data.
- ? The Holy Grail: True interoperability. True interoperability as defined by HIMSS is “… the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.” Having a patient’s record sent seamlessly electronically from one provider to another or from any testing to a provider is essentially what providers and patients hoped for with the widespread adoption of EHRs. Some say it will never happen. One excellent overview of Health Information Exchanges discusses the challenges ahead.
I certainly don’t expect the end of MU to lead to the demise of EHRs as occurred in the NHS of Britain. One positive outcome of MU was the widespread adoption of EHRs. At the same time, the EHR became the face of all of digital health for most providers, possibly making the adoption of other digital tools more difficult. In the end, the MU carrot was more of a stick. MU was designed with regulators at its center and not patients. If a technology or strategy in digital health (or anything in healthcare for that matter) is designed with the patient in mind, it has a much better chance of succeeding.