Beyond Meaningful Use: Thoughts on the Next Stage of HIT’s Evolution

Written By Kaeli Yuen

Last week, a Senate hearing of the Committee on Health Education Labor and Pensions (HELP) discussed issues related to health information technology (HIT), including the much-debated topic of the timeline for Stage 3 of the Meaningful Use (MU3) program. MU establishes Medicare and Medicaid incentives for the use of electronic health records (EHRs) to improve care, in part by providing patients with timely access to EHRs.

Senator Lamar Alexander (R-TN), who has previously called for delaying implementation of MU3, pushed to delay the final MU3 rule until Jan 1, 2017. He reports finding that providers are “terrified” of MU3, and argues that we will not achieve our ultimate goal of helping patients by forcing the implementation of MU3 “fast and wrong.” The American Medical Association (AMA) and the College of Healthcare Information Management Executives (CHIME) have also called for the delay of MU3.

In contrast, witness Eric Dishman, Intel Fellow and general manager for health and life sciences at Intel Corporation, argued that we are in the middle of a difficult transition with HIT, that MU3 is far from the end, and that we should forge ahead without delay.

There are pros and cons to both sides of this argument, but whether we delay MU3 or not has little importance in the grand scheme of how HIT is evolving. Though the MU program has had its heart in the right place, MU1 and MU2 have been time consuming and expensive, have created headache for providers, and have not proven very successful in achieving the ultimate goal of helping patients.  Unfortunately, the hassles involved with EHRs have had the unintended  consequence of making HIT and MU in particular look to providers like a burden rather than a helpful tool.

Even after the final stage of MU has taken effect, much future effort will still be needed to achieve the promise of HIT. These efforts need to look very different from what has been tried so far. Here are three important issues that we believe should be given attention in MU’s successor:

• Providers’  attitudes toward EHR technology. Many providers view EHRs as a source of headache, and are growing increasingly frustrated with the lack of dividends they see EHRs paying. A major reason for this dissatisfaction is that current EHR technologies don’t cater much to the provider user experience, because the development of these systems has been largely disconnected from the end users.  Future HIT incentive programs need to prioritize the HIT user experience, and cleanse the bad taste of botched efforts to force HIT use from providers’ palates. The goal should be for providers to engage with HIT and become more involved with its development, so that the government and EHR companies are not alone at the helm of the ship.

• HIT education. Efforts should be made to engage providers with HIT early in their careers; i.e. during their training. Despite the major role of EHRs in medical care today, and the even larger role they will play in the future, curriculums do not offer much education on their use, other than the trickle-down from mentors to students of bad habits and attitudes toward EHRs. Clinician educators often instruct students in the ways they have learned to weave and side step through the hurdles imposed by EHR. This represents a major problem. One remedy, aside from the necessary step of fixing EHR usability, is to educate and excite students about EHR technology early on, with the hope that they will take an active role in advocating its use.

• Rapid iterations of EHR systems. The major EHR systems of today have grown into large, entrenched monoliths, and implementing a system upgrade  for one of these EHRs is a costly ordeal that can take a hospital years to complete. During this time, hospital IT departments are tied up with the upgrade and unable to consider new software implementations. Instead of a way to make progress, upgrading a hospital EHR is more like a double hitagainst innovation. In contrast, other modern technology has become very successful through rapidly iterating on ideas. MU’s successor needs to promote splitting up these large EHR systems into smaller, more manageable, pieces, and encourage rapid iterations so we can more quickly reach our goal of improving patient care.

Ultimately, whether MU3 is enacted before or after Jan 2017 will not play a big role in HIT’s long term evolution. MU does not touch upon many of the major underlying barriers to improving care through HIT, but lessons learned from its valiant efforts are important for guiding our next steps. We are excited to see and be a part of what comes next.

Kaeli Yuen works for Akido Labs, a company that brings modern data management technology to hospitals. Learn more at www.akidolabs.com.