MU stage 2 is making everyone miserable. Patients are decrying lack of access to their records and providers are upset over late updates and poor system usability. Meanwhile, vendors are dealing with testy clients and the MU certification death march. While this may seem like an odd time to be optimistic about the future of HIT, nevertheless, I am.
The EHR incentive programs have succeeded in driving HIT adoption. In doing so, they have raised expectations of what electronic health record systems should do while bringing to the forefront problems that went largely unnoticed when only early adopters used systems. We now live in a time when EHR systems are expected to share information, patients expect access to their information, and providers expect that electronic systems, like their smartphones, should make life easier.
Moving from today’s EHR landscape to fully-interoperable clinical care systems that intimately support clinical work requires solving hard problems in workflow support, interface design, informatics standards, and clinical software architecture. Innovation is ultimately about solving old problems in new ways, and the issues highlighted by the current level of EHR adoption have primed the pump for real innovation. As the saying goes, “Necessity is the mother of invention,” and in the case of HIT, necessity has a few helpers.
The American Recovery and Reinvestment Act of 2009 (ARRA), sometimes called the Stimulus Act, was an $831 billion economic stimulus package enacted by the 111th Congress in February 2009 and signed into law on February 17, 2009 by the President.
It included $22 billion as incentives to encourage adoption of certified electronic medical records in hospitals and medical practices. The rationale behind the policy directive was clear: system-wide implementation of electronic medical records enables improvement in diagnostics and treatment coordination, fewer errors, and better coordination of patient care by teams of providers.
Almost immediately, the medical community cried foul.
Their primary beef: the cost to implement these new systems would not be recovered by the incentives.
Similarly, physicians pushed back on the conversion of the U.S. coding system from ICD-9 to ICD-10. They did not question the need for the upgrade: the increase from 19,000 to 68,000 codes is necessary to more accurately capture all relevant clinical aspects of a patient’s condition and align our data gathering with 20 other developed systems of the world where ICD-10 is already used.
That health insurers, medical groups, hospitals and others must use the same coding system that reflects advances in how we diagnose and treat seems a no brainer. But some physicians pushed back due to costs and disruption in their practices.
Last week, physicians won a battle: the Centers for Medicaid and Medicare Services (CMS) announced it was delaying the deadline for implementation of ICD-10 for a year, to October 1, 2015.
I’m often asked why healthcare has been slow to automate its processes compared to other industries such as the airlines, shipping/logistics, or the financial services industry.
Many clinicians say that healthcare is different.
I’m going to be a bit controversial in this post and agree that healthcare has unique challenges that make it more difficult to automate than other industries.
Here’s an inventory of the issues
1. Flow of funds – Hospitals and professionals are seldom paid by their customer. Payment usually comes from an intermediary such as the government or insurance payer. Thus, healthcare IT resources are focused on back office systems that facilitate communications between providers and payers rather than innovative retail workflows such as those found at the Apple Store.
Last week I heard uber marketer Seth Godin speak about the power of fear. Fear is one of the strongest human emotions, based in the core of our brain–the “lizard brain” that evolved prior to our higher order thinking skills. Fear served us well throughout most of ancient history (stay away from the tiger!)–but it’s not always productive in modern day society.
Consumer fears about health information technology (health IT) privacy are a case in point. Surveys show that more than half of consumers voice fears which are, (in my opinion) appropriate, to an extent: risks such as discrimination are real, and public concerns should hold policymakers, vendors, and providers to the highest standard of privacy protection.
The real problem is fear mongering. Debroah Peel, founder of Patient Privacy Rights, has put herself and her organization on the map with sensationalism. As she said in a KTVU report earlier this month: “Anything that’s in there, any information that’s in there, can and will be used against you in the future. It’s very important to know that in the electronic health world…” and, “This is a nightmare. It’s nothing we’ve ever seen before in medicine.”
Extremist statements like this are usually misleading and often just plain wrong.. But a response that focuses on the logical and rational alone doesn’t cut it. In March Peel wrote an opinion for the Wall Street Journal online called “Our Medical Records Aren’t Secure.”
It got 179 comments. A measured rebuttal by Mary Grealy, President of the Healthcare Leadership Council, got only 4.Continue reading…