Meaningful Use Challenges – software or process?

Responses continue to roll in after the Dec 30, 2009 final rule proposal from The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).  As expected, there are some positive and some critical comments.  From reading them, one cannot help but wonder what percentage of the challenges raised are due to poorly designed EMR (or EHR) software and what percentage are due to clinical processes that resist change.  I suspect a good portion the problems are due to software.

EMR and EHR software have been in the market for many years, though many have not  delivered on their promises.  In fact, a friend in the business once said the product he sold probably bankrupted a number of medical practices due to problems with the billing and other modules.   Those who have purchased these software and experiencing problems are rightfully concerned that they not only have to spend money to swap out their current EMR, but they may also lose out on the EHR incentive money.

However, from an objective observer and healthcare consumer’s point of view, I believe the Meaningful Use goals are worthy and necessary.  What needs to happen is for the software vendors to respond to the complaints of the purchasing doctors as well as Meaningful Use requirements.  This press release by research firm KLAS points out some of the feature gaps that need to be plugged.

There is indeed a market opportunity for EHR and Health 2.0 tools delivered as SaaS as The Health Care Blog says.  They are more flexible, more integration friendly and less costly to implement (at least from an infrastructure perspective).  Those who have already implemented a clunky and inflexible system, ironically these are probably hospitals and financially endowed practices, can be seen expressing concerns such as “unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification”.

This will continue to be a space to watch, whether you are a technologist or a medical professional.  There is hope yet EHR will learn from consumer web innovations that millions have been using for a number of years.

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Quick Tests to pick EHR by

This is a short article crediting another author for creating the criteria with which to select an EHR. There are so many vendors and so many sales people out there telling you their wares are the best but little assistance for the medical practitioners who need to choose these tools in the time that they do not have.

For those as confused as I was a couple of weeks ago about these jargons, an Electronic Health Record system (EHR) is a superset of Electronic Medical Record (EMR) and Personal Health Record (PHR) systems.  The stimulus money from the Obama administration to encourage the adoption of software technology in medical practices is for EHR as it requires the introduction of both clinic and patient facing features.

This is the original posting by Peter Beck from which the summary below was created:

  1. Any Information To Be Filed Must Have Doctor Approval Or Awareness
  2. External Resources To Take Care Of Scut In A Cheap, Dedicated Fashion = PASS
  3. Get Doctor Signoff Before Proceeding With System Changes — Repeatedly
  4. 1-Click Is Best, 2-Clicks Is Status Quo, Anything Else…Not So Good
  5. Pare With Care
  6. Always Customize By Provider, If You Have The Option
  7. If Something Works, Copy It Shamelessly

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The slow revolution in Healthcare IT

For years, healthcare IT has been dominated by big players and arcane system architecture that resembled the ERP market in the 1990s.  Playing into this is the vendor dominated CCHIT certification process, which required everything under the sky to pass, but did little to ensure the software support a better care delivery or even integration with the disparate systems used by different physicians.  However, there are reasons to be optimistic as 2009 comes to a close, as written in this blog.

Looking at healthcare IT, I see a lot of parallels to how the enterprise IT space has evolved over the last 15 years.  There were many promises and much money spent, but little to show in the form of tangible quality improvements or cost savings.  Sure the marketplace will eventually sort out winners and losers, but I postulate that government stimulus money will make the outcome of this evolution different.

Granted, what needs to happen in this space isn’t limited to just moving the power from traditional HIT vendors.  The interoperability in HIT in general is abysmal.  Even new vendors aren’t much better at allowing physicians and patients share data.  However, there are reasons to be optimistic that people building HIT software would consider a multi-tenant system or a data sharing platform a fundamental requirement instead of an afterthought.

What do you think?  I am especially interested in hearing from those who are involved in healthcare delivery.  After all, I am peddling wares just like everybody else.  You the user should have the final say.

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