Electronic health records and meaningful use took heat at a recent panel that featured two EHR vendors and a CIO user. But the consensus was that EHRs, despite shortcomings, are shuffling in the right direction.
The electronic health record got a grilling at a session I moderated last week at a national healthcare journalists' conference.
At the Association of Health Care Journalists annual conference, held in Silicon Valley, the most intense interest was reserved for a panel in which the e-cigarette industry defended its products. Meanwhile, I presided over the inquisition of EHRs.
Market leader Epic Systems had declined my invitation to join the panel, but two other EHR vendors were game, as well as the CIO of the highest-acuity children's hospital in the U.S.
The audience came with its best curveballs, and the best of all was thrown by "data journalist" Fred Trotter, no stranger to these pages. During my session, Trotter announced and produced fresh insights from a new joint project between his DocGraph project and his analytics startup, CareSet Systems, to unlock which providers are using which EHRs, and how well each provider is doing at achieving the goals of meaningful use of EHR technology.
In typical Fred Trotter style, there was no press release, just Trotter showing up and showing how the data jockeys in the audience could use meaningful use data being reported to CMS to shed insights on how well EHRs are doing.
On my panel was Kyna Fong, co-founder of Elation EMR, a newer meaningful use-certified EHR company that touts ease of use and focuses on the kind of ambulatory practices that have previously resisted meaningful use. Elation has even managed to convince some practices to switch from rival EHRs, assisted them in doing so, and claimed to make that easy for them, at a relatively low cost.
Such EHR switching costs, or startup costs of any sort for that matter, have been traditionally a pricey affair. For that reason, a lot of the practices that brought in Elation have had their EHR deployments funded by hospitals, either through alliances or outright acquisitions of practices by hospitals. More on that below.
Trotter informed Elation that via his analysis, most of its customers had performed well on the measures that indicate physicians are indeed entering vital signs dutifully, which is one of several dozen metrics that comprise the initial stage of meaningful use.
Trotter even called out a few physicians whose metrics fell short, but he was more interested in asking Fong if she, and the other EHR vendor on the panel, felt his analysis was fair.
The answer I heard from Fong was: sort of. "We spend a lot of time convincing our physicians to actually attest for meaningful use, because their initial reaction is like, 'Well, that's not that much money, and I'm sure it's a terrible process, because it's from the government,' " she said. "So we spend a lot of time talking to them."
Part of what Elation says distinguishes its EHR is the ability for providers at a glance to tell which patients are in compliance with particular measures and which are not. But Fong admitted that some providers were at least partially gaming the meaningful use system. "Some of them are like, 'I'm going to hit the minimum percentage for every measure. The minimum I need to do, I'm going to do. I'm going get my dollars, and then I'm going to ignore it,' " she said.
Fong notes that EHRs, and CMS's meaningful use program, can do only so much to truly generate meaningful use of EHRs. "We can't make [physicians] use it in a particular way or document in a particular way," she said. "We can remind them and make it easier, but ultimately that part's up to them.
Ed Kopetsky |
"Could we invest in innovation and functionality and capabilities in our product that move the needle more for patient care than us trying to make meaningful use easy? Absolutely. I could think of so much stuff we could do that's so much more needle-moving and impactful to patients."
Count on the patient perspective being a big part of the debate as we see public comment pour in on the proposed stage 3 rules, as well as the modified stage 2 rules also currently out for comment.
Another EHR vendor on the panel felt that the meaningful use program is "directionally correct" but may fall short of the big goal of the program: total patient record interoperability.
"I think we are going to get to interoperable systems," said Michael Blackman, MD, chief medical officer at EHR vendor McKesson Enterprise Information Solutions. "I'm not sure it's going to be based on the meaningful use arc, however. The meat's really in stage 3. That's all about using the information to really improve health. I think the jury's out."
At which point, the CIO on the panel, Ed Kopetsky of Stanford Children's Health, pointed out that meaningful use has nevertheless laid the groundwork to benefit patient care in the future.
"I see a lot of innovation coming, and it wouldn't have happened without a lot of base infrastructure installed," Kopetsky said.
Kopetsky doesn't see how independent ambulatory practices can go it alone and still meet the various quality measures, value-based incentives, and sheer IT infrastructure that government is demanding. "In the last three years, we bought 40 clinics with 130 providers, and that wasn't the role of a children's inpatient setting anywhere before, but basically the new healthcare reform has pushed us toward this," he said.
On top of integrating this acquisition spree, Kopetsky's marching orders are to innovate. Already he is working with Apple's HealthKit technology to allow families of children with Type 1 diabetes to monitor their status and upload data for inclusion in the Epic EHR. "It is early in adoption and it is difficult," he admitted.
The grilling about EHRs continued, with even the EHR vendors noting some continuing technology challenges. Take alert fatigue. "If I'm a nephrologist, getting an alert that my patients have abnormal kidney function is really annoying, because all of my patients have abnormal kidney functions," Blackman noted. "I'd be more interested for it to tell me the patient had normal kidney function. So how do you balance that?"
A more serious concern is patient safety implications of the EHR. "Because [information] is 'in the system,' there's this sudden belief that [the physician] must have seen it," Blackman said. "The human capacity to absorb that information is no different because it's in a computer than it was in a stack of paper. Now that said, I should be able to find what I'm looking for." All panelists agreed that the best EHR implementations put the truly important patient information front and center, but of course the devil's in the details.
Kopetsky summed up on an optimistic note. "This is not the time to question, Are EHRs correct? It's a question of, How do we make them great, and advance."
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.