Electronic health records hold great promise for improving healthcare delivery and patient outcomes, but the Meaningful Use program incentivizing people to adopt EHRs has several flaws that are impeding these goals.
For instance, says Carl Bergman (pictured), a consultant who serves as managing partner of EHRSelector.com--a free service that enables providers to compare different ambulatory EHR products--interoperability should have been a primary focus for ONC and the program from Day 1.
"They screwed up royally," he says.
In an exclusive interview with FierceEMR, Bergman shares other insights about the program, including his recommendations for the future.
FierceEMR: What's your overall view of the Meaningful Use program?
Bergman: Meaningful Use could have followed what the Veterans' Administration did with VistA: roll out a basic system and expand on that. Add the HL-7 protocol, and you would have had a national system for interchange.
Instead, in Meaningful Use, they included all of these nice-to-know things like smoking, but that's not as important as having core elements and getting EHRs to talk to each other.
You can't roll out a complex system without having a basic system first.
FierceEMR: The focus, then, should have been on interoperability?
Bergman: Interoperability was part of the promise of EHRs, so the fact that we don't have interoperability adds to the problem. CVS is more interoperable than EHRs.
Meaningful Use requires some interoperability, but it's the craziest system, using "test pilots."
FierceEMR: What happens now?
Bergman: ONC could do some things. [National Coordinator for Health IT] Karen DeSalvo may have the strength and ability. She has already shown willingness to not stand on ceremony and act quickly and independently to reduce the number of committees.
She has also said that she wants to get beyond Meaningful Use.
FierceEMR: Where else could change come from?
Bergman: I hate to say it, but the single way for immediate passage of a change is for something horrible to happen, such as a patient safety issue in a hospital. There may also be user revolt.
I want users to have a place at the table with vendors. Hospitals may also turn to hiring their own people rather than vendors, and rework their databases into more useful common databases.
FierceEMR: Is there anything else you'd recommend?
Bergman: Vendor contracts should have at least a core of standard provisions, like they do in architecture contracts. The contracts are currently too idiosyncratic.
And they should do away with gag clauses. Vendors are throwing away good information [they could be getting from providers].
This interview has been edited and condensed for clarity.