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Do Criticisms of Certified EHR Adoption Miss the Point?

Healthcare CIO John Halamka counters criticism of certified EHR adoption and progress toward EHR interoperability.

By Kyle Murphy, PhD

- The past week has seen two expressions used recently to voice dissatisfaction with certified EHR adoption — "snake oil" and "bear trap."

But those criticisms are not shared by Beth Israel Deaconess Medical Center's CIO John D. Halamka, MD, MS, who counters that programs to increase EHR adoption of certified technology have achieved specific goals as originally intended.

"As a country, we invested $35 billion to move existing transactions from paper to electronic form and 85% of our clinicians/hospitals achieved that," he wrote on his blog, Life as a Healthcare CIO. "We also required patient access to educational materials, which have appeared in the form of a multitude of standalone apps. We did not suggest a fundamental redesign of healthcare workflow, we suggested a digitization of existing paper processes. We accomplished exactly what we set out to do."

Similarly, the healthcare industry has made definite strides in information sharing, population health, and patient engagement if approached objectively, said Halamka.

Advancements in certain types of health information exchange and interoperability are examples of EHR adoption-related successes:

Did we share data? Some would argue that we have not achieved interoperability. However, what is your definition of interoperability and the criteria for success? The work of the past decade has focused on e-Prescribing, public health reporting, and laboratory resulting. All of those have been achieved with very high adoption rates. We did not focus on pulling data from disparate sources so that information is available at the point of care just in time. We accomplished exactly what we set out to do.

Halamka's comments are in direct response to remarks made by American Medical Association Executive Vice President & CEO James Madara, MD, over the past weekend.

Ineffective EHR technology, direct-to-consumer digital health products, and EHR interoperability were all examples of what he called the "digital snake oil of the early 21st century."

"More and more we're seeing digital tools in medicine that, unlike digital tools in other industries, make the provision of care less, not more, efficient. And these digital tools often don't connect with each other—interoperability remains a dream," he told attendees. "We were told that interoperability was the future; we didn't expect that it would always be in the future."

According to Madara, many have profited by making "extravagant claims" about a decreasing role for physicians and increasing role for patients regarding the latter's ability to provide their own digitally-aided care. These are the snake oil salesmen AMA leadership consider responsible for complicating rather than simplifying care delivery.

For Halamka, these criticisms of certified EHR technology (e.g., design, usability, interoperability) are based on a different set of expectations than those responsible for informing EHR standards and specifications used as part of programs such as meaningful use:

Rather than suggest that vendors are selling the electronic equivalent of snake oil, the AMA should recognize that the regulatory efforts of the past several years have achieved exactly the result that was intended and that stakeholder organizations such as the AMA should suggest a small number of desirable outcomes as our next goals. Government should provide incentives to achieve those outcomes via MACRA/MIPS and the private sector, working with stakeholders (patients, payers, and providers) should innovate to deliver the needed technology.

While Halamka's comments were not in response to a recent editorial in the Journal of American Physicians and Surgeons equating certified EHR adoption to bear traps, they do provide a counter argument to this claim.

"Meaningful Use has achieved its goals and we need to accept that the journey we’re on is incomplete, not off course. We all need to unify on defining the future we want and aligning government, providers, and industry to establish a trajectory to get us there," he concluded.

The main takeaway from the healthcare CIO's post is the importance of acknowledging the role of EHR adoption and use to date as setting the foundation for future innovations and advancements.

Dig Deeper:

AMA: EHR Interoperability Part of Today’s Digital Snake Oil
Has Adoption of Certified EHR Technology Trapped Docs?



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