When the HITECH Act first came into play, it was meant to spur widespread EHR adoption to help the healthcare industry achieve the Triple Aim. But with every improvement, there have also been EHR challenges for providers to mitigate.
Many healthcare professionals have reported improved patient safety and more accurate clinical documentation by using EHR systems, but they have also encountered several challenges — ranging from difficulties meeting the demands of quality reporting programs to setbacks linked to poor system usability.
EHR quality reporting
Meaningful use is the federal program credited by government officials with sparking the widespread growth of EHR use. As a result of EHR incentive payments for the use of the certified EHR technology, an increasing number of healthcare professionals adopted EHR systems.
However, these programs quickly came to present several problems. In the second phase of the Medicare EHR Incentive Program, Stage 2 Meaningful Use, healthcare professionals realized they would have to depend on others — providers and patients — in order to meet reporting requirements.
Slated to begin in 2018, Stage 3 Meaningful Use has likewise imposed burdens on healthcare organizations and providers. Although this set of requirements now only applies to eligible hospitals and critical access hospitals, many are still feeling challenged to meet interoperability, patient engagement, and clinical quality measure requirements.
In lieu of Stage 3 Meaningful Use, eligible professionals — now known as eligible clinicians — will have a new program to contend with — the Quality Payment Program. Starting in 2017, these providers must report participation in the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs), comprehensive reporting programs integrating many of the same principles of meaningful use and other quality reporting programs.
Preparing for MACRA implementation has already served as a source of frustration for providers, so much so that CMS recently announced plans to ease first year requirements of the Quality Payment Program, granting providers several different ease-in options to help them transition.
EHRs have improved elements of clinical documentation, helping to improve patient safety. However, technologies from different vendors don’t always play nice, presenting issues when one patient receives treatment at two different points of care.
Robust EHR interoperability is crucial for care coordination and patient-centered care. However, reports show that it is seriously lacking in most EHR systems. Although interoperability and health information exchange are both significant aspects of meaningful use and the Quality Payment Program, providers are still being hung up on the issue.
That being said, the industry is working to solve these problems. Application programming interfaces (APIs) such as the Fast Healthcare Interoperability Resources (FHIR) show signs of a better future in health IT, as do federal visions for advancing healthcare interoperability such as the ONC Health IT Interoperability Roadmap.
Perhaps one of the biggest health IT-related provider gripes is EHR usability. Many report that EHR technology add to rather than subtract from provider workloads — owing to something as basic as poor navigation.
Recent research shows that 92 percent of nurses are dissatisfied with their EHR technology, and much of those negative feelings are attributable to complicated interfaces. Eighty-five percent of nurses said their EHRs consistently had flaws or technological glitches getting in the way of their workflows.
EHR usability issues are also getting in the way of patient and provider relationships, with 90 percent of nurses reporting this.
Another recent survey from the American Medical Association shows that for every hour providers spend face-to-face with patients, they spend another two working on clinical documentation and desk work. This shows that providers have too much work to do on their EHRs, and that it is getting in the way of delivering personal and patient-centered care.