The role of a physician in an EHR rebuild

The adoption of technology in health care has been unique. While other industries adopt new and developing technology out of the need for innovation and interest in new products, the majority of physicians have adopted technology into their medical practice because the payer-the U.S. government via Medicare-has required it.

In 2011, the Centers for Medicare & Medicaid Services (CMS) launched Meaningful Use (MU). As defined by CMS, MU is wherein eligible professionals use certified Electronic Healthcare Record (EHR) technology to:

Improve quality, safety, and efficiency of care, and reduce health disparities

Improve care coordination and public health

Improve clinical outcomes and increase transparency, among other objectives.¹

While it is important to enhance practice in the medical community through technology, and this opportunity has allowed for rapid and dynamic growth among EHR vendors, has this growth been worth the subsequent growing pains? They include:

Increasing screen time for physicians (less time with patients)

Technology interference with face-to face care

Overwhelming change in workflows

For physicians who were not already technology inclined, many have scrambled to get on board with Meaningful Use. Now that many are utilizing EHR technology, working through the various MU stages and learning new workflows and software updates, how are they feeling about the value of electronic documentation?

The American Medical Association (AMA) and the Medical Association of Georgia held a town hall meeting this past July to give physicians a chance to voice their concerns about the future of MU, and attendees were heard loud and clear: Meaningful Use cannot progress until existing issues such as clinical interference caused by EHR workflows are addressed.²

Legislation has been introduced by U.S. Rep. Renee Ellmers of North Carolina that addresses many of these complications in MU and encourages flexibility and enhancing electronic health records to improve patient care and access to health information. The AMA has declared strong support for this legislation. ³

EHR companies have a vested interest in the enhancement of clinical care and improved patient outcomes, so physicians' adoption of EHR technology and subsequent satisfaction is important.

Wayne Kotzker, MD, of Renal Electrolyte and Hypertension Consultants in Ft. Lauderdale, Fla., believes that, while physicians would have likely made the switch to electronic health records eventually, adoption would have been more successful if it happened at the user's pace. "Had the government let us adopt naturally, it would have happened in a more 'meaningful' way;' said Kotzker in an interview for this article.

"Many of us were adopting at our own leisure, but all of sudden everyone was being forced into it. I understand the need, but those of us trying to find what's best for us and our practice were rushed to make a decision that should have been made more thoughtfully"

The pre-determined measures of MU have not allowed for the natural adoption and progression of EHR technology. It's not to say that there haven't been any successes. Digital health care is successfully updating our industry; however, EHR users as well as vendors feel pressure to meet requirements, rather than improve systems to enhance health care outcomes. "Vendors have spent years tailoring software to meet the requirements of the government, which often takes time away from meeting the needs of physicians as users to improve patient care;· says

Emily Bonham, Director of Product and Marketing at Falcon Physician. "We would have liked to spend more time on usability and workflow to help physicians improve patient care. This is always a main focus; however the more requirements there are, the harder it has become to account for everything MU requires"

To date, many systems do not effectively interact, share information, and create the desired unified electronic chart MU intended. Furthermore, the push for demonstrable improved patient outcomes based on a slew of governmental requirements is difficult to identify. "When we consider other purported benefits of the program- standards by which to electronically exchange information, ease of moving from one system to another, and improved patient care...all of these have yet to consistently materialize throughout the industry" says Justin Williams, product manager at Falcon Physician.

Issues surrounding the lack of interoperability between EHR systems remain a major frustration among physicians. According to Dr. Oliver Khakmahd of East Bay Nephrology in Berkley, Calif., the lack of data sharing needs to be addressed. "EHRs do not even speak to each other. I do not see how this is improving care;· he says. "Information exchange should be the priority."

Chart building vs. patient outcomes: What Is Important?

Interoperable charts would be a huge win for EHR systems, but the true measure of success will be demonstrated improvements in patient outcomes. When looking at other industries such as telecommunication, the advancement in technology has not only made communication more convenient, it has improved the user's experience and enhanced the capabilities drastically. The adoption of mobile technology occurred organically as users adopted based on the progress of the technology's design, and the industry has flourished.

"In the long run, electronic health records are worth the stress of transitioning from paper, just as in the case of the evolution of most industries," said Kotzker. "A digital record that captures massive amounts of data, creating a comprehensive record accessible at every point of care, will aid in the progress of care. That is the ultimate goal of medicine: to use any advancement to improve overall care and health for and health for all."

While the path toward improved patient outcomes lies ahead, the measures and milestones have made the journey a bumpy one. There has been no time to step back, evaluate results, and give physicians and designers a chance to breathe. "This has been done with the best intentions, and now we want to see the results;· says Bonham. "Billions of dollars have been spent, and the investment needs to be justified with results, rather than continued spending."

East Bay Nephrology's Khakmahd expected to see more results by now. "The government needs to evaluate the progress made in the last several years and reevaluate the goals of the program and measures in place. This should lead to better outcomes and benefits for the patient, and it currently does not," he said. However the value of this technology is not to be overlooked.

"Despite the challenges of EHR implementation and adoption and decrease in efficiency and productivity of physicians, creating a comprehensive record accessible at every point of care has significantly improved access to patient information when needed to make important health decisions and hopefully advance clinical processes and improve patient outcomes," said Khakmahd.

While user-requested updates won't necessarily help meet MU, they will improve the user experience and con tribute to improved patient care. Steps in this direction are being made. The aforementioned legislation from Ellmers will add pressure to the government to relinquish sole control of the way electronic health care is conducted and input from those who build and utilize technology can point things toward a better utilized and functional tool. The Office of the National Coordinator for Health Information Technology (ONC) recently announced that it is looking for applications for the Health IT Policy (HITPC) and Health IT Standards (HITSC) Committees to help define the future of MU requirements.³ We are headed in the right direction.

By taking a step back to ensure patient care remains the focus of MU, and this program and technology will con tribute meaningfully to this mission, we feel confident that EHR will continue to become the asset to patient care it is intended to be. -by Kari Holloway; Matt Brill

References

Meaningful Use Definition & Objectives. http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

Mills R. AMA supports legislative effort to revise the Meaningful Use program. AMA News Room, 2015. http://www.ama-assn.org/ama/pub/ news/news/2015/2015-07-30-legislative-effort-revise-meaningful-useprogram.page

Health IT Policy Committee. http://www.healthit.gov/facas/health-it-policy-committee