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Thursday, June 8, 2017

"EHRs are a dying technology?"

From yet another press report on the eClinicalworks fraud settlement:
The eClinicalWorks False Claims Act case: Implications for health IT

Experts say the False Claims Act case against eClinicalWorks highlights problems in health IT that center on a lack of interoperability, the failure of meaningful use and the failure of electronic health records, or EHRs.

The Department of Justice noted in its press release about the case that a lack of interoperability played a role: "ECW's [eClinicalWorks'] software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW's software to the software of other vendors."

Kirk Nahra, an attorney at Wiley Rein LLP in Washington, D.C., who specializes in privacy, information security and compliance issues, explained. "One of the points [of these EHR certification requirements] ... is [for] systems to be able to work together," Nahra said. "[It's] the whole idea of interoperability."...
To Kate McCarthy, senior analyst at Forrester Research, this case just reinforces something she's believed in for a while: "It's kind of mystifying that they were able to get away with this as long as they did. But my opinion on health records has been, for a while, that [EHRs are] a dying technology."

A perfect design for failure

McCarthy explained that healthcare organizations try to use EHRs to run hospitals and drive everything, from scheduling to patient workflow to revenue cycles, in addition to using EHRs simply as clinical document storage -- which is what they are more suited for than anything else, she said.

"They're systems of record," McCarthy said. "They're not systems of insight, and they're not systems of engagement. And so the way that people have tried to make them work in the industry was basically a perfect design for failure."

But more than the failure of EHRs, McCarthy said she believes this case against eClinicalWorks also demonstrates the failure of meaningful use.

"The issue I see is more that meaningful use, in and of itself, is a pretty big failure," she said. "And even organizations that are successfully attesting meaningful use are not meeting customer organizations' expectations with the products and services that they're delivering."

She added that "not only have we not [achieved meaningful use], but now vendors are out there faking meaningful use attestation."...

I know critics are having great sport these days piling on the Meaningful Use program, summarily calling it an unequivocal "failure." While I have never held fire criticizing the initiative where I found it necessary (e.g., "interoperababble," anyone) -- even while working for the HealthInsight REC --  I'm not so sure. I find the results decidedly mixed.
Responses shortly (my daughter's been finishing chemo round 3 today). First of all, briefly, I take issue with the summary conflation: whether the Meaningful Use program has "failed" (in what regard?) is a separate issue from whether EHRs have "failed" (and, they decidely have not; paper charts are not "better," the converse is true. All we can differ over is the relative extent).

None of which is to argue that the "current state of HIT is 'acceptable'." When you work in QI, little to nothing of the status quo is ever "acceptable." Technology is never static, and to the extent that dominant market incumbency stifles 'innovation" in any business/tech domain, it has nil to do with technology per se. (And, yes, I'm hip to the phrase "regulatory capture." I dispute the extent to which it applies in Health IT -- in marked contrast to, say, the FIRE sector.)

Two broad accusations stand out in general as proffered by MU critics: [1] "Interoperability" has yet to be accomplished, and [2] we have failed to "bend to cost curve (down)."

Fair enough. Search back through the MU-governing ARRA/HITECH Act (Public Law 111-5, pdf). Interoperability is alluded to exactly twice, once with respect to "promoting research into interoperability (which has indeed commenced, however haltingly)," and once touting the (obvious) utility of interoperability with respect to pubic health databases and "registries."

Search also on "cost curve" and its numerous synonym phrases. You won't find anything. For an in-depth at why health care costs continue to rise despite all of the policy chatter and health IT initiatives, you can't do better that Elisabeth Rosenthal's fine book "An American Sickness." Yes, it was hoped and intended that HIT would play a role in reducing health care costs, but other far more potent economic factors keep confounding that goal (and, we simply cannot know where costs would be today absent the significant accelerated penetration of HIT pursuant to HITECH).


Coming shortly, after I look into this (below) further.

A "free" 8-week online course.
"Participants in this 8-week course will engage with top experts in the field of public health as they grapple with the nature of high-quality healthcare: What is quality? How do we define it? How is it measured? And most importantly, how can we make it better? Whether you’re a healthcare provider; student of medicine, public health, or health policy; or a patient who simply cares about getting good care—this course is for you."
We'll see what's new since I got my health care QI Cert in 1994.

More to come...

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