The Battle to Move U.S. Health Care From Paper to Digital Far From Over
By: Traci Badalucco (US News) November 2015
If you have gone online recently to pay a hospital bill, request a prescription refill, or look at lab results, you are among the minority of people across the U.S. using technology to monitor your health.
Moving patient health records from a paper-based system to an electronic one has long been a dream and a goal of doctors, hospital administrators and policymakers, but the effort has been anything but seamless, according to a recent Government Accountability Office report.
“If an ATM puts somebody else’s money in your account, nobody dies,” said Chuck Christian, board chair at the College of Healthcare Information Management Executives. “But if we mess something up, it could very well impact someone’s life.”
Stakeholders interviewed for the report agreed that electronic health records, the digital version of a person’s medical history, are essential to providing optimal health care throughout the U.S., but some were concerned with how quickly the government is moving to achieve it.
In his forty-plus years in the health care industry, Christian said he’s never seen such a rapid rate of change. “We are doing a heart transplant on a marathon runner while he is still in the race,” Christian said.
Using electronic health records to provide better care, also known as meaningful use, was mandated in 2009 by the Centers for Medicare and Medicaid and the Office of the National Coordinator for Health IT.
The three-stage initiative has a tentative 5-year time frame and would eventually eliminate the need for standard manila folders containing a patient’s medical history. Stage 1, the first step for those joining the program, began in 2011 and focused on getting participants to record data in a standardized, electronic format.
Moving records off of paper and online is only half of the battle. One of the main objectives behind meaningful use is involving patients in the process, but to to do so, patients have to access a portal after a hospital or a doctor’s visit. To enter the portal, patients click on a URL link in an email, where the system generates a unique patient number and a temporary password. Once the password is changed, they use it each time they log on to do things like make an appointment, fill prescriptions, and communicate with doctors.
But health care professionals say it hasn’t been easy to attract patients to the portal, and they feel pressured if they don’t meet the government’s quota.
“All of this has resulted in frustration from physicians who feel they are slowed down and less effective at their work,” said Dr. Steven Stack, president of the American Medical Association and an emergency physician in Lexington, Kentucky. “There are patients who feel that their health care providers aren’t able to pay full attention to the patients themselves because the doctor is consumed by this technology.”
Before Oct. 6, one of the objectives under stage 2 required authorized users, including medical professionals and hospitals, to direct 5 percent of their patients to the portal, where patients are to view, download and transmit a summary-of-care record, which contains information like demographics and lab work.
Those who failed to meet the 5 percent quota were docked incentive money under the EHR Incentive Program, but were able to apply for a hardship exception. According to CMS, after listening to feedback from industry workers, medical professionals and hospitals are now required to direct just one patient to the portal until 2017, then that number will increase to 5 percent. In 2018 and beyond, it will increase to 10 percent.
In 2014, 48.18 percent of Medicare eligible professionals, and 64.67 percent of Medicare eligible hospitals met the stage 2 requirements, which included the 5 percent quota and 19 to 20 other objectives, according to CMS. Both were given a flexibility option if they failed to meet the requirements, in which they could remain at stage 1 for 2014: 51.82 percent of eligible professionals and 35.33 percent of eligible hospitals utilized the flexibility option.
There are many reasons why people aren’t interested in entering the portal, said John Glaser, senior vice president at Cerner , a health information technology firm in Kansas City, Missouri that provides services to more than 18,000 facilities in more than 30 countries. Glaser says because the majority of the population is healthy, they aren’t yet concerned with monitoring health conditions and are less inclined to use the technology.
He also said IT professionals need to make the technology more user-friendly.
“We don’t design them as well as we should with the consumer in mind,” Glaser said. “We don’t need all this stuff.”
Dr. Stack agrees. He says long drop-down menus and long lines of text make the process tedious and can generate documents up to 70 pages long.
“As an emergency physician, I may need to know very specifics things,” said Dr. Stack, stressing the need for customization. “We could make it much more useful to the doctors and to the patients, but we could also make it a lot easier to put data into the system.”
This lack of software standardization proved to be a big hurdle in achieving interoperability, according to the Government Accountability Office report, also making it difficult for a primary care doctor to send an electronic health record from a clinic to a hospital if the two aren’t using the same software – the essence of interoperability.
“It’s like putting four or five kids in a sandbox and giving them all the rules, and those kids don’t play by the same rules,” said Randy McCleese, chief information officer at St. Claire Regional Medical Center, a rural, stand-alone Catholic hospital in Morehead, Kentucky.
Despite its problems, the idea of converting medical records to a digital format is that doing so would reduce the number of patients who die because of medical error. It is estimated that between 44,000 and 98,000 people die in the U.S. each year from preventable medical errors, according to an Institute of Medicine report.
Systematized electronic health records could decrease that number and help doctors make informed decisions in treating a patient they’ve never seen.
“I’m looking at a comatose patient, and I am thinking, ‘If I only had access to that information to be able to treat them,’” said Dr. William “Tripp” Jennings, system vice president for Palmetto Health in Richland County, South Carolina.
Getting those systems into standardization mode is up to IT vendors supplying the software, and most are onboard to fix it.
“The intention was good for meaningful use,” said Helen Waters, vice president of sales and marketing at Meditech, which provides software to 2,300 hospitals in the U.S. “We just need to refine that so it’s a consumable amount of information.”
At a recent summit in Orem, Utah, 12 of the biggest health care software vendors in the U.S. spent two days identifying how best to achieve interoperability and possible solutions to move the needle forward.
KLAS, a healthcare technology research and insights firm based in Utah that organized the summit, measures progress in the healthcare industry without bias, said founder Kent Gale. “It took a huge amount of effort to put this summit together, and we did it because we think it will make a difference.”
Gale said vendors agreed that using metrics to gauge interoperability is essential to know where there’s room for improvement. KLAS will spend the next six months surveying health care professionals who use the technology, says Gale, to see what information they find useful in their day-to-day work. “It isn’t whether you got the information, but was it helpful.”
He said they will start the questionnaires in mid-November to get a baseline, then adjust accordingly and continue the process for four to five years to get an accurate measure.
With most big changes, experts say it takes time and patience to get things running smoothly.
“The issue is not unique to EHRs, and in fact you often see these kinds of issues whenever a new technology is adopted within an industry,” a CMS spokesperson told U.S. News in a statement. “It takes time, the adoption of standards, as well as industry pressure to achieve compatibility across systems.”
“This is remarkable in its potential,” said Dr. Stack. “I would crave to have access to medicine history or to their [patient’s] lab data, it would make it so much easier to provide higher quality care, but folks who want to get there too quickly and to mandate too many things are stifling the very innovation that we need to get those things to really work.”
Lawmakers are finalizing the third and final stage of the program, in which all providers are required in 2018 to meet objectives outlined under the three stages. They recently opened a 60-day comment period in which providers may offer feedback surrounding stage 3 requirements.
