EHRs: We Have Barely Scratched the Surface
For the last six years, the rush to install electronic healthcare records (EHR) in the entire United States healthcare industry, has been driven almost exclusively by the U.S. government’s proverbial “carrot and stick” approach. Originally, it offered $30 billion (USD) in incentives that one day in the not-too-distant future will be deemed wasted – this was the “carrot.” The “stick” was the mandated reductions or penalties in reimbursement if providers did not comply. Today that penalty is 3% of all government paid healthcare, increasing to 5% in 2019. We must realize the U.S. government is the largest payor of healthcare in the entire world, paying approximately $1 trillion (USD) for Medicare and Medicaid.
The Meaningful Use (MU-2) Certification must be done annually by providers that are part of the program with only some exemptions and hardship waivers allowed. The MU-2 requirement covers government programs only. It is not rare to see a medical office that handles Medicare and Medicaid differently than they handle insurance and private pay. For the most part, we have had little enforcement of the annual certification, though we expect that could change very soon.
If the Trump administration wants to reduce regulations, it should freeze Meaningful Use today and delay MACRA. Why?
Meaningful Use has not worked. For the last five years, the drive has been compliance, not improvement of care or improvement in communications. Other than cloud-based or Software as a Service (SaaS) – still a minority in today’s electronic health record users – there has been little innovation.
That lack of innovation is the reason why research alone cannot effectively demonstrate how EHR use has led to better quality. There is empirical data that suggests that EHRs have likely introduced accidental billing and coding errors due to the ease of creating medical notes.
Nearly 95% of EHRs currently in use are comprised of all acute-care hospitals and around 70% at the provider level. However, it is very common for providers to only use EHR for government programs. This also gives us the confirmation that the true innovation is missing in most EHRs.
A recent report noted that the Ambulatory EHR industry was growing to over $5 billion annually by 2021. That is a compounding rate of nearly 6%, yet we have little evidence it has improved care.
Nearly all acute-care EHRs do not connect to Ambulatory EHRs, and most Ambulatory EHRs make it difficult to aggregate patient information or allow doctors to share live data.
At the same time, the U.S. government continues to drive towards managed care, accountable care, and value-based reimbursement. The concept is that these historical and emerging models will provide better care and lower cost. However, most EHRs were not designed for that task.
Clinical decision support system (CDSS) is a key opportunity that interconnected EHRs can improve. It can connect an entire care team. Economists believe that the value alone of CDSS will increase to over $1.5 billion by year 2021. Combining interconnected EHRs with interconnected CDSS could justify the hundreds of billions of dollars invested in EHRs over the last six years.
We have been disappointed in the lack of focus that has been given to practical and care related applications in EHR design.
We built PWeR® (Personal Wellness electronic Record®) to primarily provide a platform for improving the quality of care, by first connecting the providers to other providers, collectives, and then connecting to the patient in a live environment. With PWeR, there’s no need send encrypted information/records across the Internet. Those records effectively become obsolete, within minutes, hours, or days of when they are sent. That should not be a novel idea, however it is.
PWeR contains robust decision-support features that allows caregivers to use technology to assist them in confirming patient care and adherence to their own medical protocols. We remain excited by the prospects of using EHRs, not only to comply with government mandates and avoiding penalties, but also as a patient centered platform and a solution for providers who are providing better, measurable care to their patients.
– Noel J. Guillama, President
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