EHRs in 2014: Nearing a tipping point

By any measure, 2014, wasn't easy on the electronic health record front. It heralded in Stage 2 of the Meaningful Use program, which brought grief to providers who struggled to meet the more rigorous requirements. The Centers for Medicare & Medicaid Services backpedaled to some extent by issuing a flexibility rule and extending some deadlines, but refused to budge on other provisions, such as a 365-day reporting period for 2015. So far, Stage 2 is limping, with attestation numbers underwhelming.

There also was a lot of talk about problems with using electronic health records and patient safety issues and but not a lot of actual change. While more providers have adopted EHRs, they're still dealing with problematic products.  

It also wasn't easy for vendors, which had to scramble to upgrade their products, some of which came under fire for an inability to share data with other EHR systems.

And it was downright unpleasant for CMS and the Office of the National Coordinator for Health IT, which began 2014 with a rosy outlook of how well providers were embracing EHRs and a new 'voluntary' 2015 edition of EHR certification; that latter concept died on the vine and limited provider attestation to Stage 2 has caused many to question the long term prospects for the program.

A harsher look at payments made

The government also took a harder look at providers who may not have deserved incentive payments, after all. Reports indicate that about 10,000 eligible professionals who received payments under the Medicare program have been audited, with about 20 percent failing those audits. If that's not bad enough, the audits have revealed gaps in the audit appeals process. 2014 also saw the conviction of the first individual for falsely attesting that his hospital had met the Meaningful Use requirements.

Interoperability, patients front-and-center

With Stage 2's heightened data sharing requirements, interoperability became a buzzword in 2014. Still, there was condemnation from Congress and elsewhere once it became known that many EHRs simply could not share data with each other.

There also were some indications that patient engagement is working, although perhaps more slowly than some would like. Still, while patients like some aspects of EHRs, they don't fully trust them, and oftentimes withhold more information from doctors who use them. And they're right. The security of the systems remains abysmal. 

2015: Into the abyss

So what will 2015 bring?

It may prove to be the tipping point for Meaningful Use, when penalties are implemented and the 365-day reporting period becomes a grim reality. Unless providers get legislative and/or regulatory reprieves, there will be a ripple effect throughout the industry. For instance, 2015 may be the year that physicians drop out of private practice.

It also will be interesting to see if ONC can succeed in reinventing itself beyond Meaningful Use as the program sputters.

The government will continue to crack down against providers who receive Meaningful Use incentive payments that are not entitled to them.

We'll continue to see EHR adoption as an incentive or requirement in more government programs and payment models, and applied to different kinds of providers. The entire industry will be nudged into EHR implementation, with or without the Meaningful Use program.

Interoperability will be a major focus, but progress will be slow.   

There's never a dull moment in healthcare. Hope you like roller coasters--we may be in for quite a ride. - Marla (@MarlaHirsch @FierceHealthIT)

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