Concerns around Meaningful Use Implementation

If one were to dig down and understand the real intent of implementing EHR and meet Meaningful Use criteria, it would be nothing but to achieve improved outcomes, better efficiencies and lesser healthcare costs. The healthcare delivery mechanism is expected to become much better as a result of this. However, somehow the focus seems to be revolving more around evaluating healthcare setups to determine their incentive payment eligibility, based on Meaningful Usage, rather than understanding the core issues which stand in the way of its implementation. In its current state, it is becoming more and more difficult for hospitals with limited resources to attain MU eligibility. The ones who fall into this category include smaller critical access hospitals and community health centers which generally treat patients with lower income and are more often than not uninsured. Although they seem to be using EHRs which are in some shape, it is in attaining MU certification where they seem to be falling short - primarily due to lack of availability of resources to invest, low patient volume and difficulty recruiting qualified IT personnel .On the contrary, the bigger hospitals with deeper pockets and superior resource access seem to be having a better ratio of eligibility.

The matter is likely to get worse when eventually hospitals start getting penalized after a few years. It will result in job losses of physicians and hospitalists employed by the smaller setups. This will ultimately lead to the whole purpose of implementing MU EHRs going for a toss. At the current rate of progress, it will be the patients who will suffer at the end of the day. This consequence was not preempted before the roll out started and hence some short-terms solutions are being suggested in order to handle the situation. For e.g. extending the last date for stage 2 implementation is one such option. The other one being mooted is that of the extending help to the struggling medical setups to expedite the process of full implementation of EHRs. Without concrete steps it would not be possible for the government to reach the stage it envisages to i.e. that of sharing patient data across providers and have clinical information following patients wherever they receive care.

One of the major stumbling blocks while attempting to qualify for the incentive program is that of meeting the requirement for computerized provider order entry. This issue seems to be more pronounced in the cases of hospitals which have failed to qualify for the incentive. It is not just the technical gaps but also the cultural and organizational ones which contribute to it. For the setups which achieved MU, the concerns hovered more on the technical front; related more towards providing patients secure and easy access to their data , identifying the factors that contribute towards the calculation of the quality measures and generating the data for the same. In a broad sense though, all this has cast a shadow on the pace at which Health IT adoption was expected to pick up and given its detractors an opportunity to hit back. Meaningful stage 2 adoption seems to be bane of many such groups. One such feels that there is not enough time available to validate the e- measures and so just implementing the software in practices will not necessarily mean that the objectives will be met automatically. Also, not every measure is of equal importance or value to every practice. For the physicians which have successfully completed stage 1, vendor readiness is posing a problem .Without the appropriate software updates and required support, Physicians will be unable to meet the Stage 2 requirements and get penalized without apparently any mistake from their end.

The general consensus is thus on extending the date for Stage 2 implementation by a year to avoid outstripping the capacities of vendors and physicians and risking complete derailment of the overall Health IT adoption process. This will allow the some exemplary practices to successfully implement Stage 2 requirements by 2014 and share their experiences and learning with vendors and providers for faster and efficient adoption at a broad scale subsequently. Healthcare software development teams can help you build projects within allocated budgets and time schedules.

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What should an ideal Healthcare Model offer?

In its current state, the healthcare industry can be best described as a combination of valuable care, overuse of some costly interventions with little proven benefit, and underuse of some vitally important therapies. The care provided in a broad sense is fragmented and has a lot of scope for being better coordinated. An ideal healthcare setting should be removed from the extremes of either a single-payer system or an unfettered marketplace - with the former having failed already and the latter highly unlikely to go the long distance. Unless strongly regulated, the private insurers are bound to have an inclination towards shedding the enrollees which cost them dear in order to avoid making a dent on their profitability. Without social insurance of some shape the interests of patients are not likely to be protected by private insurance companies for the obvious reasons that they are business entities first. Besides the point mentioned above an optimal insurance structure also needs to be a deviant from a typical high-deductible plan. It has to be one which subsidizes high-value care while imposing a greater cost sharing on care of lower value. The later step would ensure that patients do not indulge in availing treatment which is not necessary or ones with limited benefits. Infact, providing people with the flexibility to decide from a host of variants seems be the best way to cater to their actual needs.

Moving forward, health reforms will have a need to focus on increasing the value that people can draw from health insurance and health care, instead of depending upon self-financing expansions of coverage. Thus, the concept of pay for performance is gaining steam as an emerging movement in health insurance. In this arrangement, Providers are rewarded for meeting pre-established targets for delivery of healthcare services. Hence physicians, hospitals, medical groups, and other healthcare providers are all required to meet certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care, which could be medical errors, or increased costs also get included as part of the deal.

A research done recently on profitability of hospitals in US came up with some very interesting data. Incidentally, the hospitals with high performance scores in patient care seemed to be the most profitable. This can serve as a very encouraging factor for providers who are skeptic about the new model. Effectively, the survey was a proof of the fact if patient experience (which has a direct link to the quality & and efficiency of care provided) is positive; there is a high possibility of financial profitability for the corresponding institutions. Thus the core of the model has to lay emphasis on providing the best of care to patients. In addition to it, there has to be strong focus on scoring high on publicly reported clinical measures. With these 2 factors taken care of, financial success becomes an automatic spin-off.

Agreeing to the fact that a value-based model shows a lot of promise and is worth investing in is one thing. But to assume that such a model would automatically ensure a higher quality of healthcare delivery would not be appropriate. Overall any new model to succeed, a couple of deliverables need to be ensured - extension of insurance protections to those who lack them and a constant improvement in the manner in which care is offered to those who are already insured. Thus, in order to successfully implement this new idea some major changes to certain otherwise archaic approaches and methods need to be made. For e.g. insurance coverage needs to be extended so as to allow more people to benefit from the protections that insurance affords and ensure that those protections are secure for those who fall ill. And, last but not the least, there is a need for people at the core of the establishments i.e. Physicians, nurses, hospitalists to bring in a few changes in the manner in which they go about performing their activities. They will need to ask the patients, which they presently do not do adequately, about their expectations. To attempt to serve them without being aware of their expectations would be utterly futile otherwise. Once this is done, then there would be the subsequent task of identifying vendors who provide healthcare IT services and then subsequent stages would involve developing the healthcare apps which is truly ‘pro-user’.

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