By now we all may be growing tired of the “it’s the economy, stupid” construction. What's more, using it for health IT is not respectful of the many people who work in the area, because they are earnestly trying to improve health. But, in many respects, the “forest for the trees” kind of reset that the construction suggests is very appropriate now. Lost in the current “it’s not about the technology, it’s about the outcomes” mantra, in the insistence that “policy always comes before technology,” and in much of “Meaningful Use” is the criticality of technology building blocks for making any meaningful health outcomes from EHRs actually happen.
Truly meaningful outcomes will not come from EHR implementations that simply make existing health processes electronic. They will come from processes that take advantage of the new capabilities the technology can unleash. But the technology elements of Meaningful Use do not now enable an unleashing of such capabilities. While some incomplete EHR implementations may be necessary on the path to improved capabilities, the way market forces constrain HIT, we need every possible dollar of HIT leverage now to advance the technical elements that can actually help generate health outcomes.
As now situated, and some would say “as usual,” providers of care bear the burden of the disconnect between EHR capabilities and health outcome expectations. Since one would be hard pressed to show a direct correlation between current EHRs and the improved health outcomes that are expected, providers are burdened with achieving the outcomes without meaningful assistance from the technology in doing so. At the same time, of course, providers also have to deal with the painful aspects of adoption.
Meaningful HIT would advance interoperability that actually reduces the costs of systems integration for providers by specifying, in detail, terminology, messages and transport for healthcare and population health needs. It would promote, not shy away from, more advanced standards for the exchange across multiple organizations of prevention schedules, care plans, analytics and other things that can enable medical management, improved processes, and better outcomes. Meaningful HIT would enable quality management, not just quality reporting, by specifying services to manage diseases as well as records, problems and medication lists. Meaningful HIT would introduce trust standards to make PHRs viable by standardizing the EHR-PHR connection and would enable providers to lookup a patient’s data anywhere it exists when they have the patient’s consent.
In thinking about the second round of Meaningful Use, we need to put as much dollar leverage as possible into enabling meaningful health information technology - not because we don’t think that health outcomes are important, but because we do. Health insurance reform and payment methodologies are appropriate settings for advancing healthcare quality. Let’s focus Meaningful Use IT dollars on enabling the meaningful health information technology that can make this work. Little about EHR adoption is about “meeting providers where they are” so why should we stop short of giving them better tools that can ensure they can do more?
John W. Loonsk, MD is Chief Medical Officer, CGI
