By Edgar Wilson, Independent Analytical Consultant
As the saying goes, what got us here won’t keep us here.
Politicians, providers, and programmers across the country by now know (or should) that bringing on an enterprise EHR system does not transform care delivery or clinical operations overnight. And the ultimate goal of getting these disparate systems employed by providers across the full spectrum of medical practice to seamlessly communicate with one another remains elusive.
What Meaningful Use did right—forcing EHR adoption—is fundamentally less complex, and less valuable, than the overwhelming cultural, practical transition incumbent in achieving interoperability.
The relatively straight-forward incentive system behind MU fell far short of winning hearts and minds. Work-around solutions, vocal resistance, and litigation all the way up through Congress demonstrated how far the technology was from true “adoption”. Casualties continue to accumulate, as professionals succumb to fatigue and frustration, opting to leave medicine altogether rather than face the bureaucracy and technocracy now taking over.
Compelling providers and clinics to buy new tools is one thing; getting the developers and the end users all to work together and ignore the deep-seated culture of competition, professional self-interest, and notions of proprietary ownership in which they operate is another matter.
As Bradley University’s Theresa Adelman-Mullally explained, “While many nursing faculty members and clinical unit nurses would espouse in principle the value of change, they resist real change because it threatens the familiar, established way of doing things.”
But that is precisely what is needed to implement the HITECH Act’s boldest initiative: developers must agree on a common language to ensure their respective systems can receive, translate, and correctly display records between various networks and systems; users must not only learn to embrace these systems-in-development on the job, they must also abandon all notions of proprietary data, put patients ahead of their organizations or practices, and generally feign as though medicine is one unified network of selfless professionals.
In short, the old way of doing things—everything—needs retooling to fit the HITECH model, incorporating EHRs, ICD-10, ACOs, patient-centered care, and above all, collaboration across lines of practice, network, and specialty.
Incentives and penalties simply cannot do the job alone. For one thing, the Fee for Service model that still prevails (amid mixed signals from the pilot Accountable Care clinics and networks) is a powerful disincentive to intra-clinical collaboration. Advancing the ACO model, in turn, is proving equally unresponsive to incentive-based programs for adoption.
Unsurprisingly, data show that those most satisfied with their new EHR tend to be physicians in a large practice and clinic groups. Early adopters, meanwhile, are frustrated to find that their cutting-edge systems were not quite ready for primetime. Those who adopted systems before Q4 in 2012 delivered the lowest satisfaction scores in the Black Book survey of physician experiences. Already, many are endeavoring to replace their old systems entirely.
Interoperability won’t fly if the systems on which it depends were only sufficient for passing MU benchmarks before becoming unworkable or obsolete.
Industry forecasts for patient adoption and demand for remote monitoring devices (and physicians tuned in on the other end) seem set to repeat the MU pattern: a host of manufacturers and programmers are already working to meet the demand. What will be done with all the various data produced by these proprietary devices? Will clinicians undertake to integrate it all into their patients’ records? And if so, what incentive would they then have to turn that data over through an interoperable exchange?
The mobile revolution has already swept through other industries, and health market promises more patients, more consultations, more volume pouring into the FFS model—but no standards to ensure any of the resulting streams of data can make a meaningful contribution to patients’ health databases across the spectrum of care.
To make accountable care work—and improve the chances of interoperability sticking—policymakers need to move past programming behavior through incentives and threats. Education—including initial certification and continuing education—needs closer integration into professional settings, and more mobility. Medical professionals need administrative and governmental support to create an environment where putting patients first doesn’t threaten the viability of the institutions and networks in which they perform.