Thanks to the Meaningful Use (MU) program, the rate of EHR adoption has accelerated over the last five years. With about half of all providers using an EHR, the authors of a new Brookings Institution brief believe it’s time to build on that success and align healthcare IT policy with newer payment models that replace traditional volume-based reimbursement with payment models based on value and outcomes.
In their brief, High Value Health IT: Policy Reforms for Better Care and Lower Costs, authors Peter Basch and Mark B. McClellan consider several problems with current health IT policy and infrastructure, including gaps in interoperability, inefficient workflows, and lack of alignment with payment models that emphasize better health outcomes at a lower cost. They acknowledge that MU has helped accelerate EHR adoption and advanced patient engagement, but also believe the program’s emphasis on specific regulatory standards for certification “may be impeding the ability of EHRs to adequately address diverse informational needs from healthcare stakeholders,” which in turn impairs EHR usability and the “usefulness necessary to enable providers to succeed in a value-based payment environment.”
Basch and McClellan point out some of the problems with existing MU policies, including:
- Too much uniformity of requirements. The emphasis on specific regulatory standards for MU don’t support the different realities of clinical care because the tools and workflows for one provider aren’t always appropriate for all providers/specialties/scope of practice area.
- Prescriptive, process-driven measures. The MU certification program prioritizes a core set of functionalities over provider-driven workflows, leading many providers to complain about the usability of MU-certified products.
- Failure to prioritize information related to cost and health plan coverage. Because current MU certification requirements don’t include access to timely, accurate, and actionable information on cost and health plan coverage, patients and providers struggle to make informed, shared decisions about testing and treatment at the point of care.
- Gaps in practical, effective interoperability. Because health plans, insurance companies, and employers typically don’t accept data in the standard interoperability format, efficient exchange of data is hindered—even when the information is collected in the EHR and exported using current interoperability standards.
To make MU more meaningful, the authors recommend policy reform that follow two major principles:
- Modify MU payment incentives to focus on value and outcomes rather than mandated health IT processes. Specifically, Basch and McClellan recommend removing the focus on defined and prescriptive workflows; tying MU penalty avoidance and bonuses to relevant, outcome-oriented measures of performance; supporting the development of value-based payment models and meaningful performance measures; and, highlighting opportunities for health IT vendors to insert principles of user-centered design.
- Support value-based payment reform by shifting federal efforts to promote interoperability from process-oriented mandates to real business cases for data exchange that increase value. Specific steps include identifying and disseminating interoperability standards that enable high value care; implementing ONC’s Interoperability Roadmap; developing more flexible and adaptive business cases for how health IT and EHRs could further evolve; increasing efforts to support standards and methods to enable reporting of outcome and value measures directly from EHRs; and, supporting more rapid progress toward timely availability of accurate and actionable information regard cost and coverage of health IT across the care continuum.
It’s a lot to take in, but Basch and McClellan have provided a comprehensive and pretty on-target summary of the current limitations of the MU program. They also offered a solid framework to spark discussion on how to modify federal policy to support new payment models–while also garnering the support of providers. The authors note that in order to achieve new goals, “providers must change their current negativity towards health IT and EHRs to constructive engagement.” To this last point I say easier said than done.
I am pleased we are discussing ways to improve IT usability and increase the focus on value and outcomes. But, to the architects and policy makers I offer this warning: providers on the front line are technology-weary and policy-wary. Federal policies have created much of their discontent and arguably what providers want most is to be left alone to practice their craft of medicine. Physician acceptance of any new policies is critical and the importance of including providers in this conversation can’t be understated.
Michelle Ronan Noteboom
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