In 2011 the EHR Incentive Program set in motion a revolutionary medical adaption that is changing the way healthcare providers care for patients. However, medicine is an ever improving practice with innovation often led by technological advances. EHR’s continue to make healthcare facilities evolve towards a totally paperless and more efficient system where information can be more readily shared by medical professionals. The efficiency of automated, electronic health records can dramatically improve communication, reduce medical errors, and positively affect patient outcomes.
After a strong era of EHR deployment, what’s next on the horizon of using technology to improve healthcare?
As technology advances, we see a prominent shift to mobile devices and wearable technology for all sorts of activities that 10, or even 5 years ago, we would never have imagined. We can now track our steps, make a phone call, and ask an unlimited amount of questions to our phones and smart watches and receive an immediate, accurate response. We can check our bank accounts and send cash on the go at the touch of a button. It can be expected then, that the medical field will not be far behind. Already we can symptom check, get a “Doctor on Demand” and get health insurance information through mobile apps. Incorporating remote monitoring systems into EHR programs and using mobile apps to integrate a national health exchange will be the new future in healthcare IT and EHR advancement.
Some hospitals have already begun to incorporate mobile patient interaction apps. Incorporating technology that can send secure text messaging, submit photos, and check out their symptoms that can be sent directly to their doctor for examination, into an EHR program would be a great advancement in the healthcare IT field. This would allow doctors to directly call patients if they feel further treatment is necessary and it would eliminate purposeless clinician visits. This information, securely sent to the clinicians, could be added into the patient’s profile within the facility’s EHR and can be used to assist healthcare professionals in diagnosing as well as treatment. However, this technology does not need to be utilized solely for post procedure symptoms.
Studies show 1 out of 10 Americans use fitness trackers today. Although a smaller number of people own smartwatches, those who do own them utilize their equivalent fitness functions. This type of wearable technology can track steps, calories, activity level, heart rate, and sleep patterns. Unlike cellphones, wearable technology is in many cases worn even when asleep. This health information is not only extremely valuable for Americans trying to get healthy and lose weight but it can also be valuable for your next doctor or hospital visit. In order to further the Meaningful Use of technology in the American healthcare system, pairing wearable technology with clinician EHR’s can be an extremely efficient and safe outlet to monitor and record patient health data. By utilizing this diagnostic equipment with apps that interface securely with EHR’s we can create an integrated health exchange.
Wearable technology can be utilized as a remote monitoring system that can relay messages back to clinicians in real-time or before their next doctor’s appointment. This will speed up the process of check in paperwork and medical questions. All of the information would be readily available to the clinician before the apt and much more information would be available for the clinician to analyze based of the information the technology picked up that the patient would not remember or be aware of. It can also set health alerts for when blood pressure or other vulnerable health levels are in a compromising and potentially fatal range. It can even be programmed to contact emergency services when necessary. The purpose of this EHR integrated technology would not only be to assist clinicians with time management and safety but also to assist their patients in everyday life.
With today’s rate of EHR clinician frustrations rising to 83%, and 34% of clinicians without a current EHR refusing to integrate despite penalties, how can we move forward to an even more digital healthcare innovation that currently would not include software reimbursement?
The first step would be not following the traditional routes when selecting EHR vendors simply because of popularity. EHR satisfaction must be improved before even newer advancements are integrated. This can be accomplished when health enterprises work with innovative vendors who have demonstrated a willingness to work with clients and develop solutions to better promote healthcare.
At a time of year when America celebrates those men and women who have served our country through military service, Meta is honored to have among us a military hero among our newest team members. Javier Tarazona spent 14 years helping to make our world a safer place through his military service, and is now transitioning to civilian life with a focus on improving patient safety through healthcare IT. It is a privilege for us to have him on Meta’s team.
Javier Tarazona has been with Meta since January 2016 as a Quality Assurance intern. His responsibilities include testing different versions of Meta products to ensure they work properly and writing reports for programmers. He works alongside them to fix any issues that arise. We asked Javier how he likes his job here at Meta, he replied,
“Meta is a company that I can grow with. Since coming to Meta I have been able to expand my skills professionally and as I grow with the company, I will continue to do so.”
Although before joining the Meta family, Javier had a very different set of job responsibilities.
In 2000, Javier joined the United States Army. Instead of computer work, he jumped out of planes, trained soldiers and fought for our country every day; It was not your average 9-5 type of job. For 14 years Javier worked as a paratrooper, Staff Sergeant and Section Leader. He was stationed in many places throughout the United States and abroad, however, his favorite station was in Germany.
“In Germany, all the people are nice and welcoming. I spent a total of six years in Germany with the Army. The lifestyle is very different there.”
Javier was also stationed in Korea and during his time overseas has visited other countries including Italy, Poland, and Austria. He also served several combat tours of duty, two in Iraq and one in Afghanistan.
Originally from Lima, Peru, Javier moved to the United States in 1994. Currently, Javier lives in Franklin Square, Long Island, a mere 10 minutes away from Meta, with his wife and two children. In his spare time, he enjoys playing soccer and spending time with his kids, Tiago and Ana. He is a senior at St. John’s University in Queens, New York with a major in computer science and a minor in healthcare informatics.
“After the completion of my degree at St. John’s, my goal is to get a full-time job here at Meta to continue to increase my skills and knowledge in the healthcare IT field. In the future I hope to attend nursing school to eventually become a clinical nurse. I may eventually go back into the military but for now these are my plans”
In the interview Javier expressed how thankful he is for what the military has helped him achieve. He has gotten to see the world and attend St. John’s University tuition-free under the G.I. bill, but really, it was not free. He has served our country in the most respectful and honorable way possible and that is what makes him Meta’s own hero. We asked Javier how serving our country has influenced his work ethic and schooling. He replied,
“The military has ingrained determination, commitment, dedication, discipline, and integrity in my personality. It has made me who I am today. The aspect of my time in the military that had the most impact on my life was the opportunity to train soldiers. I was able to be a role model for them. I directly impacted their life. Just like a father figure, I taught them to be a good person as well as a good soldier. Those would be my proudest moments”
On a less serious note, we wanted to get a feel for who Javier really is. We asked him to answer two questions with the first thing that came to his head.
If you could visit anywhere in the world where would you visit?
“I would visit Machu Pichu, Peru. Even though I am from Peru, and I go back there often to visit family, I have never made the hike up to Machu Pichu. It is truly said to be one of the seven wonders of the world.”
Name one thing on your bucket list.
“I would have to say I would want to go on a cruise. I have never been on one before. All I can think of is Titanic when I imagine a big ship so I haven’t wanted to push my luck after two tours but one day I will go on a cruise.”
At Meta, we take time out this Memorial Day weekend to remember those who made the ultimate sacrifice while serving our country. We are so thankful to have a hero such as Javier on our team of committed professionals and we thank Javier for all he has done for the U.S.
After his speech at the J.P. Morgan Annual Health Care Conference,
and the ensuing tweet that rocked the #HITsm sphere:
In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something better #JPM16
— Andy Slavitt (@ASlavitt) January 12, 2016
CMS Acting Administration Andy Slavitt, along with ONC Director Karen DeSalvo, released their latest declaration on the future of Meaningful Use. However, while the message boasted progress and promised reform, the ‘grand’ gesture left many unanswered questions. At face value, their strategy glazes over many of the more important criticisms pundits have launched against the EHR incentives program.
If we read between the lines, however, perhaps we can begin to decipher their clichéd ideology:
Where We’ve Been
As we mentioned in a speech last week, the Administration is working on an important transition for the Electronic Health Record (EHR) Incentive Program. We have been working side by side with physician organizations… [and] while we will be putting out additional details in the next few months, we wanted to provide an update today…
Okay, but getting to the point…
[Congress passed t]he Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare payments will be determined moving forward… [and] continues to require that physicians be measured on their “meaningful use” of certified EHR technology for purposes of determining their Medicare payments…
Sure, that sounds great—but what does that all mean? Give us something concrete.
As we move forward under MACRA, we will… be guided by several critical principles:
1. Rewarding providers for the outcomes technology helps them achieve with their patients.
2. Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
3. Leveling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs…
4. Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology…
This all sounds really familiar… Didn’t you say essentially the same thing back when this whole “Meaningful Use” was started, almost seven years ago?
1. “Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care.” – gov [Clinical Quality Measures Basics]
2. “Promote technical innovation using adopted standards” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
3. “Promote interoperability” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
4. “Encourage participation and adoption by all vendors, including small businesses…” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
If that’s the case, then how exactly we are ‘transitioning’ away from the current program?
The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input…
We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
So, for those of you following along at home, this is the brilliant plan to improve EHR usage: first, announce a ‘new’ strategy (which is basically a recycled version of the old strategy); then, have everyone adhere to the same old guidelines?
How will Meaningful Use be effectively ended and “replaced with something better,” if we can see no recognizable direction from the federal government?
Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use. This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually.
Unfortunately, this doesn’t address any of the real problems. We need a concrete plan of action, not just principles and reiterations. What does it take to initiate a plan that actually works, instead of just making a patch job of what we have now?
I sense stall-tactics on the part of the CMS and the ONC. Maybe we have become complacent. Have we not put enough pressure on our leaders to take action? Whatever becomes of this ‘shake-up,’ surely the nonsense must end.
However, I can almost guarantee that the process will not be quick; and it certainly will not be painless.
The accompanying cartoon is property of the University of Pennsylvania, as it appeared in the Pennsylvania Gazette in February 2014.
[Slavitt, Andy, and Karen DeSalvo. “EHR Incentive Programs: Where We Go Next.” The CMS Blog. 19 Jan. 2016. Web. 04 Feb. 2016.]
User satisfaction is potential. It’s a building block for the future. It enables providers to derive maximum value from their electronic health records, ensuring success post-implementation. In order to truly ensure user satisfaction, however, EHRs must be flexible. They must be capable of adapting to present-state workflows in order to adequately address the needs of both patient and provider. Because of this, EHR flexibility is essential to user satisfaction—and the key to patient care.
Several important characteristics must converge in order to ensure EHR flexibility—specifically those pertaining to patient safety. Clinical decision support, patient management, workload management, and patient documentation are examples of functionality that should reflect the needs of the patient population. EHR flexibility ensures that providers are able to configure this functionality in a manner adequate to their unique clinical setting.
An EHR should reflect the needs of the provider population, in addition to the patient population. This is a largely misunderstood portion of the EHR process that is especially crucial when considering future adoption. The only way end users—doctors, nurses, pharmacists, and everyone else in between—may use this technology to positively impact patient care, is if they are satisfied with the tools at hand.
A flexibly-designed EHR transforms alongside providers, to advance their mission, even as technology and practices change. Systems must be capable of adapting to different workflow models, clinical disciplines, and communication methods, particularly due to the variant nature of health care providers. With the hyper-competitive nature of the health IT industry, providers must demand improvements in three key areas as a result of EHR deployments:
1. Provider Satisfaction
2. Clinical Efficiency
3. Patient Safety
Each of these areas is crucial to advance the mission of health care. However, like a house of cards, patient care is a delicately constructed hierarchy. It is important to remember that each of these points is important both independently, and in how it relates to the others.
The shortcomings of the “one-size-fits-all-EHR” mentality have finally come to light with the recent incentives shakeup—in spite of the mission to achieve “meaningful use.” In truth, the EHR incentives program has been in desperate need of reform since its inception; and the recent hardship exemptions bill is only symbolic of the apparent legislative indifference. It did nothing to address the problem of “minimum” requirements, made no attempt to encourage data uniformity and interoperability, and continues to neglect the importance of EHR flexibility.
Establishing standards for EHR flexibility is paramount. As functionality should conform to the client’s needs, things such as program interface engines, documentation, external reporting, decision support, and data sharing should be tailored individually for each client. Additionally, vendors should encourage implementation plans and system functionality that adhere uniquely to their clients’ realm of work. With the advent of what some consider the “Death of Meaningful Use,” providers must demand solutions capable of adapting to the unique needs of their environment.
In addition, the “all-or-nothing” approach to EHR incentive payments must be replaced by a more flexible, merit-based payment model. However, this logic must also be applied to forthcoming federal EHR laws. Incentives should be goals-oriented instead of structured as pass-fail. Furthermore, these goals should be appropriate to the provider’s patients and clinical workflow.
EHR flexibility will help to bridge the gaps created by a flawed incentives program, as it transcends several aspects of health care operations. It is meant to play an important role in improving patient care. Increasing EHR flexibility will enable providers with the means to embrace change—only then will they be able to use innovations in technology to truly transform patient care.
As we waited for the ball to drop on 2016, President Obama signed a bill into law that aimed to “ensure flexibility in applying the hardship exception for meaningful use.”
Congress’ proposal seemed a noble cause: relax federal impositions to encourage health technology development. As federal mandates have become extraneous, and even burdensome to certain health care providers, changes should be made to the EHR incentives program. At least, that was the argument.
So, when pressured multilaterally by providers, developers, and health care experts to actually do something, Congress did what it does best: (virtually) nothing at all.
Meaningful Use is in desperate need of reform. Its problems are inherent in its structure, which an adjustment to “hardship exceptions” hardly begins to address. Congress mandated payment adjustments for providers who are not meaningful users of Certified Electronic Health Record, essentially penalizing them, instead of encouraging future adoption.
However, the heart of the matter lies in the lack of flexibility given to providers, and lack of innovation afforded to EHR developers. By holding everybody to the same standard, the program has hampered the market’s collective ability to innovate.
Push-back has been consistent, most notably from the AMA. As recently as December 15, just three days before the bill was approved by congress, the AMA pleaded with CMS and the ONC to amend Meaningful Use restrictions, and not for first time:
Stage 3… continues to restrict innovations in technology for patients and physicians and creates barriers in moving to the new Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs)…
MU measures currently define patient engagement in a narrow manner without recognizing the vast opportunities of new technologies. Similarly, the MU program’s pass-fail structure is at odds with moving towards measuring and assessing care improvement.
The recently-signed Patient Access and Medicare Protection Act pushed back filing deadlines on hardship exemptions for eligible professionals until March 15, and eligible hospitals until April 1. It also granted the CMS the ability to batch process hardship applications by categories, instead of by the previous case-by-case method.
Detractors of the program have heralded flexibility as crucial to restoring success in EHR incentives. However, with a verifiably defunct Meaningful Use program, those calling for reform will continue to face an uphill battle. In the face of such criticism, and with such actionable room for improvement, the bill is really nothing more than half-hearted attempt at appeasement.
While Congress could have just as easily accepted its limitations and made the changes necessary to ensure future success, Meaningful Use is still in desperate need of reform. A whole laundry list of items could have been addressed: the pass-fail design, data uniformity, incentives structure, and more. Most importantly, replacing often arbitrary requirements with goals-based incentives would, more than anything else, drive improvements in care, and innovations in technology.
Most sane people would agree: when the government stifles innovation, the status quo must be changed. Yet, it seems lawmakers (and their beneficiaries) are either too ignorant, or too proud, to admit their shortcomings.