April 2, 2014

What EHR Vendors Won’t Tell You: Point/Counterpoint

Electronic health records (EHRs) are the new normal in healthcare. There are as many opinions on their efficacy and overall effect on the practice of medicine as there are EHR vendors.

In some form or another, nearly everyone involved in the healthcare industry agrees that EHRs are a good idea. The agreement typically ends there. Who should pay for EHR? Who owns the data? How can patient data be transferred while maintaining Health Insurance Portability and Accountability Act (HIPAA) privacy standards? The questions, and the various opinions, can seem innumerable. Below, we highlight several of the most common points and counterpoints offered on EHRs, Meaningful Use, and the direction of the healthcare industry as a whole.

Cost:

Point: EHRs are too expensive. Hospitals and large providers can afford EHR implementation, but small providers and single physician practices cannot.

Counterpoint: If cost is the only thing keeping a provider from implementing a solution, there are several free EHR programs available. Some are ad-supported, while others are designed to introduce physicians to a vendor’s product suite. If free options make providers uncomfortable, financing is also available from traditional sources and select EHR vendors.

Point: Many EHRs are extremely inefficient. The same data must be entered multiple times in multiple forms. Because of these inefficiencies, implementing an EHR will cost a provider far more than just the licensing fee.

Counterpoint: Some of that redundancy is there by design, in order to improve patient safety. Ensuring better outcomes for patients is the primary reason for most improvements in medical technology. However, it’s no secret that some EHRs are just poorly designed. The best EHRs achieve balance between patient safety and clinical efficiency.

The only way to determine which EHR is best for you is by researching and testing multiple EHRs to make sure they align with, or can be adapted to your clinical workflow. According to several physicians interviewed by TechnologyAdvice, the right EHR can actually improve efficiency.

Meaningful Use:

Point: The Meaningful Use incentive programs are great, but providers aren’t eligible for payments until after the purchase and implementation of an EHR. How is this supposed to help providers struggling to make ends meet, let alone pay for an expensive new program and training staff?

Counterpoint:  While the Centers for Medicare & Medicaid Services (CMS) website specifically states that “the EHR Incentive Program is NOT a reimbursement program for purchasing or replacing an EHR,” there are workarounds. Providers lacking the immediate resources for an EHR can take advantage of any of the options outlined under the “Costs” subsection above. Once the incentive payments kick in, providers can then pay back financing, or switch to a paid solution.

Point: EHR vendors seem to be focused only on meeting Meaningful Use incentives criteria. What happened to increasing the portability of patient data, and the ability for providers to share knowledge?

Counterpoint: Unfortunately, this seems to be largely true at the present time. According to a recent RAND study, “both primary care and subspecialist physicians noted a mismatch between meaningful-use criteria and what they considered to be the most important elements of patient care.”

In the same study, one physician said “I think [the EHR] was created to get us a gold star for ‘meaningful use’ but not make it easy for a physician [with] boots on the ground to use it…so I think what we’ve created is almost a monster, when really what we were shooting for was good patient care.” However, when the incentives expire, EHR vendors should stop concentrating on incentive compliance, and re-target their efforts in a more patient-centered direction.

Point: An embarrassingly small percentage of EHR vendors are ready for Meaningful Use Stage 2. How are physicians expected to comply with the rules and avoid reimbursement penalties if the programs they’ve purchased aren’t Stage 2 compliant?

Counterpoint: Obviously switching vendors is a less than ideal (or non-viable) option for the majority of providers. Thankfully, CMS and the Office of the National Coordinator (ONC) announced in December 2013 that the deadlines for Stages 2 and 3 Meaningful Use attestations had been extended to 2016 and 2017, respectively.

Interoperability/HIE:

Point: Even though the majority of physicians are now using EHRs, electronically sharing data is nearly impossible unless they’re in the same practice. The majority of providers still send each other labs, images, and other health information via fax or CD/DVD.

Counterpoint: Despite the proliferation of Health Information Exchanges (HIE), only about 30 percent of doctors are able to exchange data electronically. Besides clinical efficiency – or inefficiency – the inability of EHRs to exchange information is the largest source of frustration for providers.

Although standards such as HL7 already exist, a universal solution has yet to be agreed upon. Most physicians agree that some standardization of data syntax will be necessary, but there is little current incentive for EHR vendors to do this.

Point: HIPAA makes it difficult for physicians to exchange patient data electronically, thereby impeding their ability to comply with Stage 2 Meaningful Use guidelines.

Counterpoint: While technically true, HIPAA in no way makes data exchange impossible. In fact, the final rule for Meaningful Use Stage 2 says that EHRs  must support multiple standards for data exchange to be certified as MU Stage 2 compliant.

The entire requirements are detailed in the final rule, but providers can rest assured that if their EHR is certified as MU Stage 2 compliant, they’ll be able to successfully undergo Stage 2 attestation. Does this mean that interoperability and HIE are assured to work 100 percent of the time? Absolutely not, but it’s a step in the right direction.

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In short, EHRs are just a subset of the greater debate on the direction of healthcare in the United States. Everyone agrees that the current system is broken, but no one agrees on how to make the necessary fixes. At least there’s a common vision for what a functioning system should look like. The journey towards that solution has thus far proven to be an interesting one.

Have any additional insights to share on EHR implementation, or MU attestation? Tell us about it in the comments.

 

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