As we approach the midlife phase of the meaningful use program it’s hardly surprising that the sharpening of knives is well underway. After all, this was one of the most ambitious programs of its time; the hoover dam of healthcare, a foundation on which modern medicine would be practiced.
Put simply, the goal of meaningful use was to replace an antiquated system of faxed paper charts with digital analogues so that the triple aim; improved patient experience, improved health of populations, and reduce costs might be realized in our overburdened healthcare system. As there was no impetus within the system to change organically, government stimulus was deemed necessary, and funds that needed to be spent were allocated to this ambitious new program.
Well, that’s all history now, as five years later we’re at something of an impasse. Most programs never fully achieve their stated goal, especially when dealing with the private sector. It’s one thing to dedicate billions of dollars to defense and manage subcontractors, it’s quite another thing to get the entire healthcare industry to march in step, and today we find ourselves in a time of great discontent.
Many physicians are infuriated with their EMRs, citing excessive times for data entry, reduced contact with patients, and an inability to bring the system into their daily workflow. The AMA has weighed in and held a series of town hall meetings during which they’ve allowed physicians to vent, while encouraging forment and sedition, and calling for an end to the federal program.
While the discontent is real, some of the ideas underpinning it are absolute bunk. A particularly hoary chestnut is the idea that EMRs don’t work because they were designed without the input of medical professionals. Folks, this is just utter rubbish. Developers do not go out and “invent” screens. We talk to subject matter experts and gather requirements, work through review sessions, and finally do validation with our end-users, before coming up with a design. I’ve never sat down and said to myself “hmmm … I guess I’ll just put some clinical signs over there, and a medication history over there”. It just doesn’t work like that.
My guess, and my experience, is that almost all of the major EMR platforms had medical staff involved in their design at every level. They guided the evolution of platforms the best that they could and then learned to their chagrin that there are many different ways to skin this rabbit. After all, the first EMRs were developed inside hospitals!
My other favorite piece of scapegoating is the idea of information blocking. We’ve all heard the stories about EMR vendors who deliberately make it hard for their software to talk to other platforms, and there certainly was an element of truth to this early on in the meaningful use program.
As the CIO at eHealth Technologies, I work for a company that communicates with 27,000 healthcare locations each month, and I’ve got a pretty good perch from which to comment on information blocking. Yes, we do see some blocking practices occurring today, but generally speaking most providers are more than happy to share data with other providers for the purposes of continuity of care, providing all the required legal constructs are in place.
Can you imagine the idea of a records office person saying “we don’t send records over the street?”. I can, because I’ve seen it first hand, but usually this is because the hospitals in question are in competition for the same catchment area and have decided to engage in anticompetitive behavior. I don’t know of many situations where exchange is blocked for technical reasons; usually this occurs because the Consolidated CDA documents required by meaningful use have inconsistencies.
Earlier in the year Epic charged once per patient to allow their records to be sent out of network. That was discontinued in February of 2015 (while I was at HIMSS), and most other vendors followed suit, resulting in a clearing of the financial hurdles, thus leaving only the technical and regulatory hurdles at the end of the track guarding the finishing line. I think it’s time to stop blaming them for information blocking, and to start looking at them in terms of monopoly power that stunts growth in healthcare.
The reality is that meaningful use has actually managed to meet most of its early, some would say simplistic, objectives. We can create data, we can exchange it, and we can mine it to help both the patient and populations of patients, and in fact we can do these things remarkably well.
In technology projects it’s common to develop tools, introduce them into the environment, and see your operational costs climb as the user base learns to assimilate the new technology. People have to learn, they have to complain, and they have to help you refine your vision into something that works for everyone, including situations where they have found unexpected ways to operate the tool. Seasoned technology managers expect this, allocate costs, and warn their business users that it takes time to settle down.
After all, we’re trying to turn the entire healthcare system on it’s head. Did anyone expect that to go without a hitch?