EHR and Practical, Tactical Outcomes

I hope people are watching the news around the Meaningful Use attestation data released by CMS recently, because it is so instructive as to the difference between where we are in health care and where the deliverers of keynotes THINK we are. Since last September, we’ve been publishing our Meaningful Use (MU) dashboard data and as of this week for example, we know that 83% of our Medicare MU doctors have attested to the measures.

But our constraints as a marketplace are at the practical, tactical level. According to our analysis, some 48% of what doctors order does NOT turn into a documented update to the chart within 60 days of that order. And we all know the average EHR makes docs go slower—causing employment by hospitals in large numbers—at large losses to the hospital. And NOW, based on the CMS data, it looks like a large percentage of docs are on track to miss a bloody lay-up of a bonus from the federal government! Do you guys really think we are going to build integrated ACOs that drive down hospitalization?

Pass it on—we are further behind than we think we are, and we need to hold ourselves accountable for PRACTICAL, TACTICAL outcomes before we even talk about grand outcomes like “total quality.” So what do we do? So glad you asked. I hazard three guesses, and you guys can throw in more… or challenge mine.

1. Make a market for health information exchange. Today, HIE is universally used as a NOUN. It’s a thing you buy from Aetna or Lockheed Martin or IBM. In every other information supply chain I know of, people who WANT info PAY others to give that info to them. They pay only when the info is delivered in usable form. This is, of course, not allowed in health care, but it can be. We should get behind legislation that allows for the most rudimentary mechanism for exchange in the history of man.

2. We should all go at-risk for results. Today, when a doc orders something, she doesn’t lose any money (and neither do we) if that order gets lost. Starting in March, we will be at risk for delivering orders to the receivers (labs, pharmacies, specialists, hospitals, etc.), obtaining the result back, matching it against the original order and either closing it or serving it up to the doc for further review. If we do all this, we get a dollar. If we don’t, no dollar. We will be at risk for clinical quality in the tiniest, most practical, tactical way. Alternatively, we can charge a dollar to the receiver if he or she is in our network, because we can send a value-added clean order with documentation… just the way it’s done in every other information supply chain. Very cool.

3. Face it about the cloud! I know I’m conflicted on this one, but going at-risk for results is against my self-interest and I am still doing that for the good of health care, so hear me out. If so many doctors can’t pick up basically free money from the federal government because they can’t get their legacy, software-based IT systems to make even the most fundamental changes to the information they capture and report, what do you think the odds are that these systems will enable going at-risk for a total hip replacement??? Doesn’t plunking a ton of balance sheet down for a single version of software actually orient docs AWAY from changes that would otherwise be good for them? I know some of you are saying, “Yes, but docs are working for hospitals now!” But be honest with yourself. With athenahealth and Google and Amazon KILLING each other to get competent developers, how many of them are going to take jobs customizing legacy software written in MUMPS (Massachusetts General Hospital Utility Multi-Programming System) at their community hospital system??? We all need to take a deep breath and just dump those old systems. I did it myself just this last year. I had a “fully paid up” copy of a legacy financal system. We finally had the courage to bite the bullet and sign up with NetSuite. We literally had a haze cleared out of our lives that we hadn’t even noticed was there. We can change and grow in basic ways, without “investments” and “project teams.” What a relief.

Okay, those are mine… what are yours?

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

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