Electronic health records faced many issues in 2015--interoperability, patient engagement, information blocking, health information exchanges, you name it.
To that end, in this commentary, I'll instead focus on reviewing two overarching themes that dominated much of 2015, and will continue to plague the industry as we head into 2016: the legal mess in which Meaningful Use is entangled and the physician dichotomy regarding EHRs.
The legal mess
I don't know of any law that was enacted with such fanfare to transform an industry--with billions of dollars in incentives--only to be so vilified just six years later. Now the program is being blamed for impeding payment reform and interoperability, being a waste of resources and money, and stifling innovation. Yes, it accelerated the adoption of EHRs, but even the Robert Woods Johnson Foundation says it fell short of its goals.
So what do we do with it? It appears to have fallen into a legal conundrum. Since no one is satisfied with it anymore, it was tweaked in all sorts of little ways in 2015 to attempt to make it more palatable--softening the requirements for 2015-2017; offering a blanket hardship exception for 2015 reporting. And that's not enough for some, who want to see it transformed, delayed, or even sunsetted.
But the law still exists and needs to be complied with, even though it's unclear how to move forward. Should Stage 3 be delayed? Will Meaningful Use still be relevant once the physicians are pulled out of the program and into the new Merit Based Incentive Program System (MIPS) created by the Medicare Access and CHIP Reauthorization Act (MACRA), the law that repealed the sustainable growth rate formula earlier this year? Can Meaningful Use even work alongside MIPS? The law is so murky that CMS reached out for help on that one.
And from a practical matter, how can the industry comply with a law if it's constantly shifting and there's the real risk--or hope--that it will change further?
The physician dichotomy
We've been told for years that physicians are unhappy with EHRs. They're hard to use, costly and impede patient relations.
And we're still hearing some of this in 2015. The American Medical Association reported that EHR satisfaction is declining, and launched a big campaign to enable physicians to air their grievances publicly and with their elected representatives. Just last week, the Association of American Physicians and Surgeons reported that physicians were tremendously unhappy with EHRs. Although arguably its survey was skewed because of the subjective language of the questions (such as whether EHRs were "cash cows for data miners") the negative sentiment is still real.
But we also heard in 2015 that physician satisfaction with EHRs was increasing. Vendors were modifying their EHRs to make them better; they could be assets if deployed correctly.
So which viewpoint is more accurate? And why is there such a disparity? Does it depend on who you ask?
Clearly the physician community is not on the same page. Physicians certainly don't have to be. But this could have deeper implications. If some practices are willing to change their approach to EHRs, does that mean that the systems will be less likely to be improved overall? Will a split among doctors lead to even more of them dropping out of the Meaningful Use program, which would negatively affect electronic data exchange? And will these issues, if not resolved in 2016, impact the success of MACRA and payment reform?
When it comes to EHRs and Meaningful Use, nothing's in a vacuum. Every change has a ripple effect. The coming year will be a pivotal one. Every ripple has the potential to become a flood.