Forget About Meaningful Use

By Ken Congdon, editor in chief, Health IT Outcomes
Follow Me On Twitter @KenOnHIT

Don’t let the title of this article fool you. I’m a proponent of the EHR Meaningful Use (MU) incentive program spearheaded by CMS (The Centers for Medicare and Medicaid Services) and HHS (The Department of Health and Human Services). I feel it has provided an industry full of technology laggards with some much needed motivation to adopt EHR solutions that have the potential to cut healthcare costs and improve patient care through streamlined electronic data exchange. Furthermore, the MU program has been careful to not simply reward health providers for installing EHRs blindly. Instead, MU aims to create a series of best practices and core measures that ensure the technology is implemented in such a way to achieve desired outcomes (e.g. higher quality of care, reduced waste, etc.).

That being said, MU also comes with a downside. Many health IT experts argue that the program is forcing many healthcare providers to move down the EHR path too quickly. Without proper preparation and readiness, these facilities could be setting themselves up for a failed EHR implementation that they may never recover from. Others argue that most EHR software is not sophisticated enough to competently satisfy the ultimate goals of MU. Moreover, this contingent claims the MU program focuses the efforts of EHR software vendors on MU certification at the expense of true product innovation. Finally, while the program has certainly served to drive EHR adoption, the promise of incentive dollars is often the only reason many providers have elected to implement EHR software. Implementing a core clinical system for the wrong reasons can be disastrous.

Now, I can quickly craft arguments against the first two MU objections outlined above. For example, the “too much, too fast” argument can be countered with the contention that many providers would have never been inclined to move down the EHR path without some sort of outside motivation. As for the sophistication of the EHR software on the market, I could argue that MU is simply ensuring that all EHR software has a solid foundation of capabilities. Once established, EHR software vendors will build upon this foundation with innovative features. I could also easily argue that a great deal of EHR software innovation has occurred since MU, and in many cases, MU has been the impetus for these product enhancements. However, the final objection is harder for me to debate because I’ve witnessed it firsthand. Moreover, it’s enlightened me to an intriguing EHR trend evident in our editorial coverage.

Most EHR Successes Aren’t Driven By MU

Since its inception in 2009, Health IT Outcomes (HTO) has documented several compelling EHR success stories. However, looking back, the vast majority of providers highlighted in these success stories were careful to note that the reason they implemented an EHR had little or nothing to do with MU. In fact, many started down the EHR implementation path prior to MU. Instead, these facilities recognized the inherent value in EHRs and identified how the technology could be applied to streamline data access and workflows, improve patient care, or solve other specific enterprise or department-level challenges.

A few examples come to mind:

• In a recent HTO article titled EHR Role Models, all three facilities highlighted — Dartmouth-Hitchcock Medical Center, MedCentral Health System, and MultiCare — stated that MU wasn’t the reason they implemented a comprehensive EHR, it was merely a positive side effect. Each of these providers realized the potential benefits of the “one patient, one record” EHR philosophy, and put themselves on a path to realize this goal early on (e.g. MultiCare began its EHR initiative in 1998). In each of these instances, their efforts have yielded positive results. For example, today MultiCare boasts notable improvements in length of stay metrics, accounts receivable days, operating margins, and medication error rates — all as a result of EHR technology.

• ENT Specialists of Northwestern Pennsylvania outlines a similar philosophy in the story Remote Scribes Put The ROI In EHRs. This eight-physician specialty practice began its EHR implementation in 2003 with the realization that healthcare was destined to become an electronic industry. Over the years, it has continued to perfect its EHR system to overcome obstacles and challenges related to the technology. Most notably, the practice integrated a remote scribe networking solution with the EHR to remove the burden of data entry from its physicians. Like MultiCare, Dartmouth-Hitchcock, MedCentral Health System, and other providers, ENT Specialists didn’t view MU as the reason to implement an EHR, but as an added benefit to using the technology effectively. The practice has increased patient volumes and revenue through use of EHR software.

 Just because MU wasn’t the reason each of the above-mentioned providers implemented an EHR doesn’t mean the program had no impact on them. On the contrary, each admitted that MU helped to influence shifts in organizational priorities related to EHRs, and even sparked new EHR-related initiatives in some instances. Moreover, while MU wasn’t the primary motivator for these providers, the end result of their efforts (in most cases) was still rewarded with MU incentive dollars. For example, MedCentral Health System and MultiCare were among the first healthcare facilities in the country to successfully attest for Stage 1 MU. This is testament to the fact that aligning an EHR implementation with the goals of your healthcare facility isn’t that far removed from MU criteria.

So, what am I trying to say with this recap of past articles? Am I trying to downplay the significance of MU? Absolutely not. Instead, I’m merely trying to illustrate that MU shouldn’t be the end-all be-all of your EHR initiative.

Hopefully, MU has prompted you to start evaluating your EHR options and map out an implementation plan. However, if your sole motivation for EHR adoption is to capitalize on incentive funds, then perhaps it’s time you reassessed your strategy. This approach to EHR adoption is likely to fail, or at the very least, frustrate you and your staff. Instead, take the time to determine how EHR software can best be applied to address specific challenges within your facility. By focusing your EHR implementation around organizational goals, you can maximize the benefits of the technology, and promote further adoption and use throughout the enterprise.