There has been an assumption that meaningful use incentive payments and the push to get all providers using computerized health record would ease the burden on providers. But while electronic health records "do have the have the promise of supporting" quality improvement and reporting, "I think in practice, there have been a few challenges," McClellan said.
First, he told the senators, many systems "have not been very well designed to put together data from a lot of different sources…to track your particular patients in the way you really need to in order to improve their care. A lot of providers are doing add-ons or modifications to systems to help make that happen now."
But second, he said, most of the meaningful use payments "have been tied to whether or not basically you have electronic record systems that are capable of doing things like tracking a patient over time, and maybe potentially reporting on quality measures, but not actually doing it."
It would be better, he said, to move toward payments based on doctors "using their systems to put this data together… Now there are some concerns that may be too big of a leap."
Elizabeth McGlynn, director of the Kaiser Permanente Center for Effectiveness and Safety Research, agreed. "There needs to be more work to make [EHR systems] readily useable and for physicians and individual practices, it's a harder climb because frankly, they're not optimized for this use right now."
At Kaiser, she says, "half of my center's budget goes to making our data useable for research and for clinical decision support, and that's just not something that everybody can afford to do."