Meaningful Use: Are We doomed to Fail?

This blog has also ran on EMR Daily News here.

April 18, 2011 marked the latest milestone in the industry’s quest for meaningful use of electronic medical records (EHRs). That was the day the attestation for the Medicare EHR Incentive Program – Stage 1 of Meaningful Use – began. With the opening of attestation, eligible professionals, eligible hospitals, and critical access hospitals can now sign in, sign up, give a pint of blood, leave a deposit and attest that they have indeed, successfully met the requirements of being a meaningful user of their certified EHR technology.

For those that are eligible, certified and successful, it’s a parade down Wall Street and big check in the mail sometime in May.

But let’s rewind this ticker-tape parade and take a deeper look at the Medicare Electronic Health Record (EHR) Incentive Program. For physicians and hospitals to successfully meet the program’s requirements there are two basic building blocks: 1) a certified EHR technology is in place and available for use; and 2) the physicians and other clinicians are actually using the certified EHR technology as prescribed.

Over the past year, there has been unprecedented attention on getting certified EHR technology in place. The 22nd Annual HIMSS Leadership Survey, sponsored by Citrix, released this February, reports that for 49% of the respondents, achieving meaningful use is their top IT priority over the next two years. It was also cited as the top priority last year by 42% of the respondents. So, for two years running, achieving meaningful use has been the overwhelming focus of IT efforts across the U.S. healthcare landscape.

Hmm, so how are we doing? Well, if the first building block is having certified EHR technology in place, the HIMSS’ survey is certainly not comforting. In the 2010 survey, just 22% reported that their EHR was fully functional across their entire organization. With all the focus and effort the past two years, the 2011 report shows an increase to just 27%. Half the industry is focused on meaningful use yet only one-quarter is prepared with technology in place. We moved the needle a whopping 5% with all that effort. If the industry’s grade was a solid C, all this focus and attention has moved us to no more than a B-. We can do better. We have to do better.

Don’t trust the HIMSS surveys? Well, just released last December, the Centers for Disease Control and Prevention posted its study on EMR/EHR Systems of Office-Based Physicians. Only 6.9% of these physicians had a fully functional system in 2009 and they only projected 10.1% to have one in 2010. And what of the studies that laid the foundation for the very requirements in place during this attestation period? Look no further than Dr. David Blumenthal, who deftly led the implementation of the EHR Incentive Program as the National Coordinator for Health Information Technology. Prior to being tapped for the role, his renowned team at the Mongan Institute for Health Policy (associated with Massachusetts General Hospital, Harvard Medical School, and PARTNERS Healthcare) published two seminal studies on EHR use. Their 2008 study titled “Electronic Health Records in Ambulatory Care” reported that just 4.0% physicians had a comprehensive EHR. In 2009, their study titled “Use of Electronic Health Records in U.S. Hospitals” reported just 1.5% of the facilities had comprehensive electronic record systems. It’s hard to argue that our first building block – a certified EHR technology – is in place.

The second building block – physicians and clinicians are actually using the certified EHR technology as prescribed – is even cloudier and likely worse. It has been lost in all the focus on putting the technology in place. And remember, the second building block is the issue that started us down the path of the EHR Incentive Program. We knew that very few fully functional EHRs were in place. And the recent studies continue to bear that out.

So, what about the studies that show use of the EHR, that show adoption? Good luck finding them. They really don’t exist. Not a published, peer-reviewed study, anyway. In fact, it looks like this first open period in the EHR Incentive Program will be our first and best glimpse into those statistics. Even so, just how good can those numbers be? If the HIMSS 2011 survey is a benchmark, and it’s the most optimistic of those I cited above, only about 25% of clinicians have EHRs available to use. Can we really expect more than 25% of the clinicians to be using EHRs, let alone using them meaningfully? They can’t use what they don’t have.

And what of truly meaningful use? Last week, I had the privilege of attending an industry event that was a who’s who of provider organization executives and physician leaders. The top issue concerning the meaningful use program was not the technologies, not implementation – it was workflow. If you cannot accommodate intelligent workflow for the physicians they will not use the EHR. Not efficiently, anyway; not meaningfully.

These leaders were not offering an excuse; they were accurately identifying our next hurdle. Capable EHRs are being implemented thanks to the carrot-and-stick approach of the EHR Incentive Program. Beyond capable systems, though, we need effective and efficient electronic records. Physicians love to use the phrase, “efficacy of care”. Well, we need efficacy of electronic health records. Whether we will admit it or not, we are in the business of healthcare. We do a great job adopting direct, patient-care technologies. We do a lousy job adopting business technologies.

How do we change? How do we truly produce the desired effect of the meaningful use of an electronic record-keeping system for efficient, safer, and higher-quality care? We have to look to other industries, instead of myopically following what the competitor across the street is doing. We need to look at the successes in other industries:

  • widespread use of Business Process Management systems (BPMs) to automate rote labor processes and improve subjective tasks;

  • imbedded, adaptive workflow to accommodate various specialties;

  • actionable decisioning and predictive analytics for the right decision at the right time;

  • customer resource management (CRM) for outstanding satisfaction and outcomes.

Other industries have leveraged these technologies to reduce costs, improve margins and garner stellar customer experience scores. Why aren’t we? In healthcare, insurers have reaped the benefits of advanced BPM and CRM to handle new lines of business such as Medicare Part D, automate claims processing cycles, and earn J.D. Power awards for customer satisfaction. We need to do the same for providers. Our EHRs should have fabulous efficiencies, with outstanding workflows for specialties, built-in intelligence, and ever-improving outcomes for our patients. We need to make our EHRs work well for physicians, make them of value to the patients, and most importantly, make them meaningful.

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