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Monday, May 19, 2014

Has regulatory compliance become an end in itself?

Healthcare IT Priorities: No Breathing Room
Regulatory requirements have gone from high priority to the only priority for healthcare IT.
Healthcare has always been a highly regulated industry, but in the last few years requirements for implementing and documenting digital healthcare systems have been piling up so fast that IT organizations have little time for anything else -- including making sure the systems they already have in place are being used effectively. The InformationWeek Healthcare IT Priorities Survey of 322 technology pros at healthcare providers shows "meeting regulatory requirements" is the No. 1 initiative on participants' minds. Most of the other items at the top of the list, such as implementing or upgrading electronic health records (EHR) systems, are also largely driven by federal government requirements.

 "The priorities we're trying to deal with right now are those being mandated," says Randy McCleese, CIO of St. Claire Regional Medical Center. "We can't do anything else. We have put everything else on the back burner except for those things that absolutely have to be done."

Against the crushing wave of requirements, what's most neglected by IT organizations is optimizing how healthcare providers use all the technology they've bought of late -- "and we've been provided with a lot of functionality in the last three to four years," says McCleese, who's also chairman of CHIME, the College of Healthcare Information Management Executives. "We've put all this technology in place quickly to meet the requirements, but we have not had a chance to make sure it's working effectively."...
 Register to get the free pdf paper. Nicely done. Sample size is a bit small, though.

The grousing about MU continues apace of at THCB: "The Case for Dropping MU Stages 2 and 3." From the comments:
I was one of the leaders in the EMR arena for many years, and was initially really excited about meaningful use. Yes. I admit that with some embarrassment now. I even was part of a CDC public health grand rounds regarding meaningful use and why it would be a good thing. Over time, however, I saw what you see now: meaningful use is not a definition of using the EMR productively; it is simply another bureaucratic layer doctors must get through before they can focus on patient care.

I do agree with items on your list, but the real benefit of the EMR is not one of documentation, it is about work-flow. Computers are good at remembering things we don’t remember, and are good at organizing information more efficiently. I would add several things that would make EMR systems more meaningfully useful:

1. Task managment. Why don’t any products focus on team management of tasks, as it is clearly one of the bigger barriers to good care. I believe that a system that focused on this would gain adoption without incentive, as it would actually make doctors’ jobs easier.

2. Information prioritization. It’s not what is put into the system that is important, it is what you can get out of it. Most EMR systems are a jumble of useless information that hides the useful information.

3. Better communication tools. We are using iChat in our office (locally hosted) and have found it to be incredibly useful to answer questions while the patients are on the phone. We can handle problems with fewer steps. There are many tools out there to make this kind of thing work. Patients could, for example, record MP3 files on their portable devices and have that upload to an EMR for handling by the office staff (in lieu of the overworked phone system).

4. Risk assessment and reduction – this is the overall goal of care: to make patients healthy and prevent problems from happening. The problem is that risk assessment tools are scarce in most EMR systems.

Our success at EMR implementation was due to our focus on it as a tool to improve patient care by transforming our workflows. As the burdens of meaninful use came on, however, the ability to do that was hampered enough that I not ony abandoned Meaninful Use, but I left the system altogether. My home-grown EMR is far more useful than anything I could find on the market.


MU is meaningfully useless for patient care,. No, it is worse than that. It is an additional impediment to patient care.

Medical care is about ambiguity and shades of gray. EHR systems depreciate the nuances of care, and meaningful ruse destroys care processes by focusing on the irrelevant.

It can be an odd combination of naive and doggedly determined, both of which might apply to this situation.

I agree that politicians being what they are, they are unlikely to pull the plug on MU because that means an admission of fault and a loss of money to the constituents that are benefitting from MU. But… I’m naive enough to believe that, with enough groundswell, we could do something, even if not outright cancellation, that would improve the Frankenstein that we created, especially if we redirected the money to better HIT uses and sustained the appeal to constituency.

I’ve always dreamt of an EMR that was designed from the beginning to support clinician efficiency; quality of care; and cost of care. And then rolled all of that together into something that looked like a project management tool, like Base Camp, that recognized healthcare as a long term project involving several project teammates that need to interact and communicate. Dropping a bill would become a natural functional outcome, but wouldn’t be the primary motive of the design.

It’s amazing to me that those of us who procure EMRs don’t insist on a downloadable, transferable patient record. How did the music industry manage to pull off the MP3 standard without a government mandate? Maybe there’s a lesson in there for us, somewhere.
Critics have been griping about these issues since I started in the DOQ-IT program back in 2005. I've been addressing them since I started this blog four years ago.

More to come...

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