New technology is supposed to make us more comfortable by instituting convenience into our lives. Yet new technology that comes with deadlines attached can have exactly the opposite effect.
Case in point: EHRs and the meaningful use program.
Electronic health records are pitched as the road to efficiency and better care, but judging by a great deal of commentary lately, the deadlines are keeping a number of questions alive and well.
Here are 5 such matters:
1. Are these policies working as we hoped they would? That was the question Utah Sen. Orrin Hatch essentially asked at a recent Finance Committee hearing in which he wondered whether now might be the right time “to push the pause button” on the meaningful use program in order to make sure it is moving the healthcare system far enough, and fast enough, in the right direction.
2. If not, can we fix the policies? Hatch’s comments follow a more extensive report by some of his Senate colleagues that itemizes and discusses in greater depth the concerns many stakeholders have been grappling with for quite some time. In the report, released in April, the senators noted that “while promoting the use of health IT is a laudable goal, a growing body of objective analysis and empirical data suggests the program needs to be recalibrated to be effective.” The specific problems cited included the lack of a clear path toward interoperability, increased costs stemming primarily from increased billing by providers, lack of federal oversight to guard against fraud and abuse, increased privacy and security concerns, and whether “the complicated patchwork of overlapping reporting and compliance requirements” will ultimately render the meaningful use program unsustainable.
3. Will meaningful use become just another political football? Hatch and company being Republicans and the Obama administration being decidedly not, some observers are afraid that meaningful use may end up impeded by the gridlock that seems to define so many other debates in the nation’s capital these days. And yet the gridlock, one could say, only reflects the fact that there are no easy answers concerning how to move forward. “If the existing meaningful use deadlines and eventual outcome milestones get extended, critics of the Obama administration get to point to yet more healthcare dollars spent on Obama's watch with too little to show for it,” one observer noted. “If meaningful use doesn't get extended, hasty implementations could lead to a series of embarrassing headlines and, in a worst-case scenario, HIT-triggered preventable patient deaths.”
4. Will we be able to keep up with the paperwork? Out in the actual healthcare sector, meanwhile, where government policies have very real impacts, many stakeholders are worried that the administrative burdens of meaningful use will end up swamping providers both financially and in terms of the time required to meet them. “Successful implementation of current policy requirements for eCQMs [electronic clinical quality measures] must be redirected so that the EHRs are working for the clinicians rather than the clinicians spending extensive amounts of time working for the EHRs,” the American Hospital Association explained in asking for a delay of Stage 2.
5. Will we be able to keep up with change? Interestingly, perhaps the least noticed matter revolves around whether providers will be able to keep up with the pace of change, both technological and programmatic, that comes with EHRs and meaningful use. According to a survey by Black Book Rankings, for instance, a sizable chunk of EHR users are already considering switching systems, and among the top concerns cited were “unmet requests for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses and the rapid EHR adoption of mobile devices.”
The overarching question, at fever pitch since national coordinator Farzad Mostashari, MD, last week announced his intention to step down this autumn, is increasingly becoming whether or not Stage 2 will be delayed, be that in whole or pieces of it?
And amid those lingering questions, anyone paying attention is at least beginning to wonder how many providers who attested to meaningful use Stage 1 won’t be similarly attesting to Stage 2. Likewise for EHRs and 2014 certification.
Some of the attrition can be chalked up to retirements or a switch in practice ownership – but there’s no doubt that the bar is set higher for Stage 2, and some providers aren’t going to be able to reach it.