MU & HITECH: The Death of EHR Innovation

In 2009 the Obama Administration became the drivers of healthcare policy by implementing a series of legislative acts including the HITECH Act and its Meaningful Use (MU) standards. Over the last eight years, sweeping reforms and regulations effectively transformed the world’s 5th best healthcare system into an industry riddled with frustration. Today, many question the advantages of such regulations while others desperately yearn for the pre MU days of healthcare.

There is no doubt MU and HITECH had positive impacts on the healthcare industry at large. For example, the Medicaid EHR incentive program has increased EHR adoption in hospitals from 11.9% in 2009 to 59% in 2014 – a nearly fivefold increase. During roughly the same period, EHR adoption in office-based physician practices rose from 48% in 2009 to 78% in 2013 (Meigs, Solomon 2). Moreover, many

“physicians perceive that EHR use yields overall clinical benefits, more efficient practices and financial benefits, and improves timely access to medical records as well as the quality of communication with other providers” (Jamoom, Patel, Furukawa, King 1).

Despite these success stories and positive claims, the introduction of HITECH and MU is not without consequence from an end-user perspective.

In the wake of HITECH and MU, many EHR vendors were forced to slam on the breaks of technological innovation in order to satisfy strict regulations. This is particularly true for small-scale EHR vendors, the forerunners of healthcare IT innovation, who must accelerate the standards of innovation to compensate for a lack of abundant resources. Unfortunately, focusing on meeting the strict standards of MU hindered the abilities of small-scale EHR vendors to work intimately with physicians and truly understand their needs. Indeed,

“many people blame the HITECH Act and its meaningful use EHR program for incentivizing software vendors to craft products that meet the federal government’s specific criteria at the expense of innovative features and functionality” (Monegain 1).

What is more frustrating for EHR vendors is the significant growth in physician dissatisfaction with their technology. In Electronic Health Record Use a Bitter Pill for Many Physicians, Stephen Meigs and Michael Solomon argue,

“a recent study revealed that the use of EHR systems is a contributing factor to professional dissatisfaction among physicians. Dissatisfaction with EHR technology is trending upward, with 12% more physicians expressing unhappiness with their EHR system in 2012 than in 2010” (Meigs, Solomon 2).

It is likely this increase in dissatisfaction can be partially linked to the continuous roll out of burdensome regulations within MU stages 1 and 2. Moreover, it is naturally expected this level of dissatisfaction will rise with further impending regulations included in MU stage 3, expected to roll out in 2018. Indeed, Dr. John Halmaka, Chief Information Office of Beth Israel Deaconess Medical Center, recently stated,

“Stage 1 created a foundation of functionality for everyone, that was good. Stage 2 tried to change too much too fast and required an ecosystem of applications and infrastructure that did not exist. Stage 3 makes many of the same mistakes as Stage 2, trying to do too much too soon. There needs to be a new approach” (Shaw 1).

But what exactly will this new approach look like?

In many cases, EHRs that were designed pre-MU originally had high user satisfaction. Unfortunately, many software systems were redesigned to obtain MU subsidies and, subsequently, user satisfaction dropped (Monegain 1). Ultimately, federal regulations have incentivized EHR vendors to produce and implement a product that does not align with their innovative missions nor meets the expectations of healthcare facilities. In turn, what was expected to be a win-win scenario has increasingly resulted in a lose-lose.

Frustration is felt on both sides; both from the EHR provider and the physician. This notion is reinforced by the recent actions taken by the American Hospital Association (AHA). On November 30th, 2016, the AHA wrote a letter to President Trump and his administration asking to cancel Stage 3 of the Meaningful Use program (Slabodkin 1). In a letter signed by 5,000 member hospitals, CEO Richard Pollack quotes, “we urge your Administration to modify or eliminate duplicative, excessive, antiquated, and contradictory provider regulations.”Pollack also noted that hospitals are advancing health information technology and must ensure they “have the workforce and health IT infrastructure to best support care delivery” (Slabodkin 1).

The same can be said for EHR vendors who would love for the opportunity to get back to their mission of providing the most technologically innovative products available. According to Charles Webster, MD,

“most physicians today would not go back to pre-EHR days, but many who used EHRs before MU use would definitely go back to pre-MU days. The incentive-driven mandates have essentially pinned down the current crop of EHR technology from significant advancements” (Monegain 1)

and may continue to do so if MU Stage 3 is implemented. As physician dissatisfaction rises, EHR innovation stagnates, and tax payers continue to support this $35 billion dollar project, it is becoming increasingly difficult for anyone to justify MU or HITECH. Perhaps this is why Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services announced,

“MU as it has existed – with MACRA – will be effectively over and replaced with something better” (Shaw 1). It is time EHR vendors get back to business and “ratchet up the competition based on features and functionality rather than merely meeting government criteria” (Monegain 1).

Until then, both hospitals and EHR vendors will have to anxiously wait until the HITECH and MU era is effectively replaced or ultimately canceled.

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Jamoom, Eric W. et al (2016). “EHR Adopters vs. Non-Adopters: Impacts Of, Barriers To, and Federal Initiatives for EHR Adoption.” Healthcare (Amsterdam, Netherlands) 2.1 (2014): 33–39. PMC. Web. 14 Apr. 2017.

Meigs, Stephen L., and Michael Solomon (2016). “Electronic Health Record Use a Bitter Pill for Many Physicians.” Perspectives in Health Information Management 13.Winter (2016)

Monegain, Bernie (2017). “Paper or Pixels? Clunky EHRs Have Providers Looking to the Past.” HealthcareIT News, 4/11/2017.

Shaw, Gary (2016). “Cerner Growing Fast, But Health Care IT Rules Grow Faster.” Investor’s Business Daily, 1/26/2016.

Slabodkin, Greg (2016). “AHA asks Trump to Cancel Meaningful Use Stage 3.” Health Data Management, 12/02/2016.