A Look at Health IT, Meaningful Use, Interoperability and Public Policy

Meaningful UseBy Sarianne Gruber
Twitter: @subtleimpact

Without Health information technology (IT), how can our healthcare system achieve better patient outcomes at a reduced cost and move from a volume to a value payment method? Brookings Institution authors Peter Basch, Mark McClellan, Christopher Botts and Pratyusha Katikanen in their March 2015 health policy brief, High Value Health IT: Policy Reforms for Better Care and Lower Cost, highlight the major challenges with existing health IT policy as well as provide policy recommendations to improve our current health IT status. Their research examines the following issues:

How does Health IT serve healthcare?

  • Health IT supports healthcare providers, patients and consumers with access to timely and accurate clinical information from electronic health records.
  • Health IT provides access to cost and coverage information without the taxing administrative process and unanticipated costs.

What is the toughest dilemma facing Health It?

  • Not having interoperability is extremely burdensome and costly by maintaining duplicative parallel systems and extra resources for additional data entry into other systems.
  • Interoperability facilitates information and data exchange platforms permitting flexible, usable and useful Health IT interactive systems.

Why the need for interoperability across information and data exchange platforms?

  • Providers can make informed shared decisions about testing and treatment for more timely, efficient and improved high-value care.
  • Meaningful Use (MU) programs require the adoption of EHRs and information exchange for improving outcomes.

What plans are in place to increase interoperability?

  • Office of the National Coordinator (ONC) for Health IT released “Interoperability Roadmap”, a ten year plan as a next step to promote a more straight forward exchange of electronic health data for a wide range of clinical, administrative and public health purposes.

Why are there gaps in achieving interoperability?

  • There are conflicting opinions on the advantages of Health IT; and not all health care providers see a substantial benefit in quality of care or simplifying patient care work.
  • The current approach to MU and interoperability will not be sufficient to enable the changes in information flow.

The authors presented an informative discussion on the impact of Meaningful Use (MU) policies on EHR adoption. On the positive side, MU has helped accelerate the adoption of Electronic Health Records (EHRs) and Health IT. It also furthered patient engagement and activation via timely access to their health information. However, an emphasis on specific regulatory standards for MU certification may have been a problem for EHRs to contain diverse informational needs from healthcare stakeholders and prohibiting providers to succeed in value-based payment plans. A “uniform” approach does not support the different realities of clinical care, which require varying health IT functionalities and tools across different specialties. A “prescriptive” approach of the early stages of MU created a core set of valuable functionalities, and with MU certifications many home grown EHRs had to be abandoned for commercial MU certified EHRs. Many providers complained about new MU certified products because of limited usability and the priority for MU designs over provider driven workflows. A limitation of the current MU certification is that it does not include timely accurate and actionable information on cost and health coverage of tests and treatments, given cost and coverage information is a critical part of patient care decisions. The paper details recommendations, proposals and policy solutions that considers modifying MU payment incentives and outcomes rather than mandated health IT processes as well as creating a real business case for practical interoperability rather than just an incentive for exporting data. Recommend reading The Brookings Health Policy Issue Brief, High Value Health IT: Policy Reforms for Better Care and Lower Cost.