- A recent article in the Journal of AHIMA (JAHIMA) examined the nation’s strategy for attaining true interoperability and high-quality care through discussions with health IT experts about the past, present, and future of health IT use.
Experts including Beth Israel Deaconess Medical Center CIO John D. Halamka, MD and National Quality Forum (NQF) Senior Director Jason C. Goldwater evaluated the effects of meaningful use, EHR use, health IT adoption, and interoperability on care delivery.
Ultimately, experts agreed that while federal incentive programs have not created the ideal health IT environment for value-based care, programs such as meaningful use were successful in laying the groundwork for future improvements.
Meaningful Use and EHR adoption
While the EHR Incentive Programs did not achieve all of its goals, meaningful use did succeed in spurring rapid EHR adoption. According to ONC, 96 percent of hospitals and almost 78 percent of office-based physicians now use certified EHR technology (CEHRT) as a direct result of the program.
“You could argue that no other industry has automated so quickly,” stated Halamka.
However, meaningful use failed to proliferate interoperability improvements or motivate providers to adopt a new, more accommodating approach to integrating technology into healthcare. Interoperability needs to improve before widespread EHR adoption will translate to the cost savings and quality improvements necessary to support value-based care.
“The [meaningful use] program was the most thoughtful national-scale technology implementation I could imagine,” said Vanderbilt University Medical Center Department of Biomedical Informatics Professor Mark E. Frisse, MD. “But like all great things, it has shortcomings. It simply takes time to assimilate new approaches. Money alone will not make cultural transformations happen as quickly as one may want.”
Further impeding progress was the absence of a compelling business case for EHR adoption. Many providers were unconvinced of the practical benefits of switching from paper health records to EHRs.
In place of practical incentives to switch to EHRs, federal incentives served as the driver for change. While many providers did not see the need for EHR technology in the early years of the EHR Incentive Programs, most healthcare executives and providers now agree healthcare delivery has changed for the better since transitioning away from paper records.
However, providers need a way to measure clinical efficiency and health outcomes pre and post-EHR implementation to fully grasp the scope of the technology’s benefits, according to IBM Watson Health Vice President and Chief Health Transformation Officer Paul Tang, MD.
This kind of analysis may be impossible without baseline data from the days before widespread EHR adoption. In the absence of concrete data demonstrating the quantifiable benefits of EHR use, providers must continue to offer anecdotal evidence of its ability to provide clinical decision support, according to Children’s Health Chief Health Information Management and Exchange Officer Katherine Lusk.
When touting the benefits of EHR technology and health IT use, providers should focus on the usefulness of health data rather than the capabilities of the EHR systems themselves.
“It’s time to move away from the EHR as the center of the universe and focus on the broader system of care,” said Frisse. “The central element is the information people need and the data that needs to be sent.”
The role of Health IT companies in enabling comprehensive care
While anecdotal evidence may encourage providers to engage in more advanced EHR use, health IT companies need to continue to innovate and collaborate to improve interoperability and care quality.
Widespread standardization will establish the foundation necessary for interoperability and yield improvements for health data exchange, Lusk says.
“It’s about going anywhere in the world and having my medical information available in real time for clinical care providers who have access to decision support and best practices that guide my care,” she said.
Experts also agreed more providers and health IT developers need to push to incorporate genomic, socioeconomic, and patient-generated data into EHR systems with advanced data analytics capabilities to allow for more comprehensive care.
“Successful HIT would be if the computer provided insights and answers to the questions that I have about a patient,” Tang said. “Artificial intelligence companies like IBM will want to partner with EHR vendors to help add this functionality to what they do.”
For their part, health IT companies should prioritize EHR usability to ensure provider satisfaction.
“In defense of the vendors, they were asked to do something very quickly,” Tang says. “Now is the time to work on improving usability. This would help contribute to successful [health IT] adoption.”
Engaging with national initiatives
As meaningful use comes to a close, interviewed experts urged providers and stakeholders to stay focused on interoperability and improvements in health IT use through various national efforts aimed at optimizing care quality.
For example, ONC recently began work implementing the trusted exchange framework and common agreement outlined by provisions in the 21st Century Cures Act. The national effort to improve interoperability combines feedback from stakeholders across the industry to encourage industry-wide standardization
Experts also pointed to an effort by the National Academy of Medicine (NAM) to devise national guidance for health IT use by publishing a series of discussion papers. The papers included insights from over 150 health IT leaders, researchers, scientists, and policymakers.
“They set forth a good overview of everything we need to do—where we are now and where we need to go,” says Frisse, one of the contributing authors. “They’re high-level, but I think that’s what we need.”
Rather than a single unified national plan, several efforts from healthcare organizations and associations across the industry will likely continue to pave the way for health IT improvements.
“There isn’t going to be a top-down government-driven plan to do this,” said Halamka. “It’s the industry recognizing there’s an urgency for doing this. I actually think we’re going to see the private sector blossom with innovation.”
In addition to stakeholder initiatives, market need and innovation will also drive progress in health IT use and interoperability.
“Sometimes you just need to let markets figure it out,” said Frisse. “Where new technologies are concerned, it can take several years for buyers and sellers to arrive at a value consensus and converge on a clear approach.
“I think in some instances, you’ve got to let the markets evolve,” he added.
Meanwhile, experts agreed regional health information exchanges (HIEs) and accountable care organizations (ACOs) will likely continue to foster interoperability improvements.
“We absolutely need to keep pushing forward and keep moving and keep understanding the barriers,” said Goldwater. “True interoperability—being able to send patient data on call, on demand, whenever and wherever it’s needed—will create a much more effective healthcare system. It would reduce errors, increase patient safety, and provide great insight into population health trends.”