Achieving Meaningful Use: Using Standards to Bring Medical Information to Practitioners and Patients

Marc Overhage, MD, PhD, FACMI
Chief Medical Informatics Officer, Siemens Healthcare
Member, Meaningful Use workgroup, U.S. Health IT Policy Committee

  • When you have a pumpkin, it’s not just about having it but using it meaningfully, such as for pumpkin pie
  • Stage 2 anticipated for being pushed back an additional year
  • Meaningful use as an escalator system towards EHRs use
  • 2011-2014 – carrot (financial subsidy); 2015+ – stick (financial penalty, such as for readmissions within 30 days, etc)
  • Nobody’s figured out how providers benefit from EHRs yet, but meaningful use subsidies can cover up to 2/3 cost of EHR implementation for ambulatory settings
  • Improving Quality of Care and Safety mechanisms
    • Stage 1+2
      • Structured data
      • CPOE
      • CDS
      • Progress notes
      • Safety (drug-allergy checks, medication reconciliation)
      • Population management
    • Stage 3
      • CDS
      • Order tracking
      • real-time dynamic dashboards
      • medication adherence
      • patient safety
  • Eligible providers (outpatient) (n=527k)
    • 9% doing nothing
    • 8% signed up with Regional center to help
    • 21% signed up on federal website (yes, this one worked)
    • 15% registered and intend to get EHR
    • 47% have EHR
  • 3-5% of providers last year said they were out due to shifting groups, restructuring/remodeling practice, or just being totally done with EHRs
  • Hospitals
    • 5% not there
    • 2% signed up with Regional center to help
    • 7% signed up on federal website (yes, this one worked)
    • 13% registered and intend to get EHR
    • 73% have EHR
  • medical group ownership has shifted from 69% physician owned in 2005 to 39% in 2010; 26% hospital owned in 2005 has increased to 58% in 2010 – trend due to reimbursement rate primarily, but consolidated EHR systems benefit from the shift; going out-of-business by some EHRs will lead to greater movement of physicians to larger health systems and then impacts pricing negotiations for services
  • CMS now driving EHR adoption, less so than ONCHIT
  • trends in 90 day performance – there’s no major change
  • transitions of care and reportable lab results were least popular feature at hospitals
  • Herfindalh-Hirschman Index Change by HRR 2006-10 – documents evolution of HIT market (doi:10.1136/amiajnl-2011-000769).  Part of the impetus of the HITECH Act was to increase the market, resolve failure to by
  • only 76 EHRs are certified for Stage 2
    • this has led to some physicians who had invested in a system, but gets kicked out, has to start over, or even lose data because of other systems falling out of the market
  • adoption is a massive challenge – Siemens can make the bells and whistles you want, but most adopters are getting systems with all features turned off to complete slow roll out due to training burden
  • interoperability schmoperability
    • certification has helped
    • teaching to the test (bare minimum) but not getting folks to move beyond the most basic expectations
    • while they can create the patient file via HL7, there is no secure method for transmission to other provider(s)
  • Quality measure madness
    • about 10% of measures are designed to support e-initiatives
    • CMS checklist
  • Documentation burden
    • 690k physicians hours per year = cost of EHR adoption (approx. 1 hour per day added)
    • challenge to put data into structured format
    • $19bn of tax payer investment pales to provider costs
  • Patient Engagement or Just Friends
    • more HIPAA violations through this initiative than entire past history of Siemens (patients leaving it behind, throwing it away in regular trashcans, etc)
    • patients like just booking appts online, getting lab results online
    • haven’t found the secret sauce to get patients more engaged
  • 2/3 of things in the meaningful use list aren’t things people want
  • HITECH Act’s HIT education has had little to no effect on improving the foundation of a workforce to help with implementation
  • Stage 3 is being defined now

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s