HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.
Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, andwhile not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.
We expect to experience bumps along the way. The core criteria for meaningful use cover several domains, and stakeholders provided a great deal of feedback to HHS after the proposed rule was issued. While changes were made, there remain some issues that may not directly be addressed by HHS but have widespread implications. I offer several for discussion below and request feedback from iHealthBeat readers.
- EHRs and health care professionals ineligible for government incentives: In its current form, the monetary incentives provided by the federal government (which could total $44,000 under Medicare and $63,750 under Medicaid for eligible providers) are not broadly applied to the entire spectrum of care providers. For example, while physician assistants and nurse practitioners are eligible for the Medicaid EHR incentive program, they are not eligible for the Medicare EHR incentive program. In parts of our nation, particularly in rural and isolated areas, nurse practitioners and physician assistants provide independent and critical care to Medicare patients. While they always work closely with physicians, they may be located hundreds of miles away.
- Meaningful use, bending the cost curve and quality of care: The widespread adoption of EHRs is expected to significantly improve the quality of clinical care; however, without concerted effort and commitment, the opportunity for bending the cost curve and improving quality of care could go unrealized. Most health systems have already made and will continue to make large investments in interoperable EHR systems, spending tens of millions of dollars on systems that will push them farther along the meaningful use spectrum. This does not, however, inevitably translate to an immediate return on investment; moreover, it may not be enough to change the quality paradigm of an institution. For example, the Veterans Health Administration has an EHR system that goes above and beyond the meaningful use criteria, but recent studies have shown that the VHA's quality of care is variable across the country. This demonstrates that even the most sophisticated and robust EHR is not alone a panacea.
- Implications for patient-centered care: There is no question that wiring the country is a step in the right direction, but will patients notice? And if so, will they like what they see? Many patients (including my own) express concern that their doctors spend more time typing on the computer than talking to them. In an age when we are embracing patient-centered care, where can health IT fit in the patient-doctor relationship? What functions of health IT do patients care most about? Potentially the following:
- The ability to schedule appointments with clinicians online during or after official office hours;
- A mechanism to receive relevant health advice or recommendations online; and
- An integrated and meaningful capacity for discharge instructions after a hospitalization. (Given the emphasis on discharge instructions and clinic visits in the core set of criteria, the next step is a patient-centered approach to ensuring that a clinic visit in the outpatient setting related to a hospital discharge is also "bundled" together with the original hospital visit, creating a more integrated picture of a particular patient's care continuum.)
Health reform has brought many changes to the health sector, most of which have been long overdue. With 58.5% of practices still using only pen and paper, we need to take advantage of this wave of change, push our comfort limits, and think about how best to augment, complement and modify the existing criteria to rekindle and reinvigorate the very reason we all went into health professions -- to deliver the best care for our patients to the best of our ability.