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What the end of Meaningful Use means for the future of electronic health records

john Squire

John Squire, President, Amazing Charts

Everyone in the world of Electronic Health Records (EHR) has been abuzz since Andy Slavitt, the acting administrator of Centers for Medicare & Medicaid Services (CMS), said publicly that the agency “has the opportunity” to sunset Meaningful Use (MU) in 2016 and that “the MU program as it has existed, will now be effectively over and replaced with something better.”

Physicians everywhere are sighing with relief because the federal government finally acknowledged that the MU program was overkill for physicians and their patients. 

The demise of MU brings new life to EHRs

Although originally supported by well-intentioned public health advocates, the ultimate manifestation of the incentive program had unintended negative consequences. It intruded on the physician’s time with patients, and propagated more costly and difficult to use EHR workflows. 

Now that MU is going away, what can we expect to see from the EHR industry? Below are three major trends that will be at the forefront:

  • First, vendors will design EHR systems with an eye on physician productivity versus regulatory requirements, which will mean taking a new look at how the software is fundamentally structured.
  • Second, the removal of incentives means we can expect to see less economic distortion in the marketplace, which should result in more competition, lower software prices and more value for practices.
  • Third, we will see MU replaced with new programs that focus on the quality of care rather than checking off boxes to document the minutia of the process.

Now let’s take an in-depth look at each of these trends.

Designing software that increases physician productivity and improves patient outcomes

Detractors of MU say it makes physicians less efficient in the exam room and forces them to spend more time typing and clicking and less facetime with patients. The reason is that most EHR systems are bloated with MU Core and Menu measures embedded in all workflows.

Now software vendors have the opportunity to strip away a lot of the check-boxes, reports, and other clutter. They can design cleaner, more streamlined screens and user interfaces that allow clinicians and office staff to complete routine tasks with minimal clicks.  

By removing MU, but retaining quality metrics, vendors also have an opportunity to make EHRs “think” more like a provider – or at least support the logical thought-process of a provider, rather than hinder or intrude upon it.

Providers think in problems, yet the vast majority of EHR systems organize data according to its type. For example, all lab results for a particular patient are displayed as a single list, regardless of the problems for which the labs were ordered. The same principle is used to organize exam notes, medications, orders, referrals, etc.

As a result of organizing data by function rather than problem, providers feel as if they are drowning in disorganized data. The capacity of providers to multitask is often stretched beyond their limits, leading to cognitive overload. This impairs the process of decision making and can lead to medical errors such as misdiagnosis and other potentially life-threatening mistakes.

One emerging solution to this issue is a problem-oriented medical record (POMR). All notes, medications, labs, orders, referrals, etc. are associated with specific patient problems. Because it organizes and presents information in the same way providers are trained in medical school to “think” about patient problems, the POMR is naturally more intuitive to use. 

An EHR organized around the patient problem list helps reduce cognitive overload in the exam room. Providers see “bits” of data – like lab results – associated with a specific problem, thus easing the number of mental connections required to make a sound, well-informed medical decisions.

Lower costs for higher-quality EHR software

Early EHR purchasers were motivated by the desire to “go paperless.” Since the return on investment of going electronic was unknown, these practices were highly cost-conscious during the purchasing process. They were also concerned with usability and wanted systems that allowed them to complete charts efficiently, as they did with paper.

In the mid-2000s, the announcement of the MU program distorted the fundamental economics of the EHR industry. The CMS incentive program created a “gold mine” opportunity in the minds of many EHR vendors. They could suddenly raise prices and point to the incentive program as a payback. As a result, physicians cared less about price and more about how quickly they could collect the first incentive for simply purchasing and implementing an EHR without even using it. 

With the MU program gone, the economic playing field can return normal. Cost and usability will again become important factors. Hasty decisions made 24 or 36 months ago are the leading reasons why there is rampant EHR switching today. Physicians are now realizing, “I can’t live with this system.”

Quality care reporting replaces MU

There are already plenty of signs that the CMS program will shift to emphasize quality of care and outcomes, allowing physicians to focus more on patients than documentation. The new program will encourage quality tracking and reporting, but limit intrusions into the physician’s workflow. The new current procedural terminology (CPT) code for Chronic Care Management (CCM), allows physicians to receive reimbursement for CCM services at an average of $42 per month for Medicare beneficiaries, and is a great example of how technology and reporting can be used to improve care coordination. This new CMS program turns the physician’s office into a hub for ongoing care between visits, resulting in healthier patients, while generating significant practice revenue for functions already being performed

As these changes occur, the EHR of the future will be able to manage them in the background, in a way that maximizes productivity and does not interfere with patient visits. 

The future is bright for providers

Better software from vendors, lower costs, and new approaches to documentation that reduce cognitive overload.  These are just some of the exciting developments we can expect to see in the EHR industry as the MU program fades into a distant memory. 

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