As the Meaningful Use Work Group of the Health IT Policy Committee prepares its recommendations for Meaningful Use Stage 3, its members should take a long hard look at the difference between the potential and the reality of health IT. If they ask for too much, many providers will be unable to keep up, and there will be pushback. If they ask for too little, many providers will be content to do the minimum required for incentives without using technology's full potential to improve quality of care.
While much has been achieved in a relatively short period of time, physicians and hospitals are making uneven progress toward the long-term goal of a fully digital, connected healthcare world. More than 100,000 providers have attested to Meaningful Use, but that doesn't mean they're all using their EHRs meaningfully.
Let's start with the fact that many physicians dictate patient history and progress notes rather than using point-and-click templates in the EHR. What that means is they're not generating the discrete data required to measure what they're doing and improve upon it. In addition, the absence of clinical data in EHR fields makes it difficult to track patient health status or send reminders to patients when they need preventive or chronic care. (Billing and scheduling data in practice management systems can be used to populate registries, but that approach leaves a lot to be desired for purposes of population health management.)
Earlier this year, a study of EHR-equipped primary-care practices in New York found that the providers missed half of the eligible patients on three of 11 preventive care measures they reported to the city. Another study conducted in a primary care network of Brigham & Women's Hospital in Boston showed that physicians omitted more than half of their patients' hypertension and diabetes diagnoses from the discrete fields in their EHRs.
This is not necessarily because the doctors lacked experience with EHRs. The Boston physicians, for instance, had had their EHR for many years.
Health information exchange is another area fraught with problems. Many physicians and hospitals cannot participate in an exchange because they either don't have a full EHR or their system is not capable of exchanging clinical data with other systems. Meaningful Use Stage 2 is designed to start breaking down these silos, but it won't be easy.
Here's one indication of the primitive state of health information exchange: Last week, the Health Information Partnership for Tennessee announced it would be shutting down. In its place, the state will promote the use of the Direct Project, a nationwide standard for clinical messaging that allows providers to message each other securely online instead of sending faxes.
Nearly 30 statewide HIEs are now using Direct messaging. While there's nothing wrong with that, some of these organizations are using Direct to jump-start information exchange because so many providers are not yet ready for more comprehensive types of data interchange.
Doctors and hospitals are also in very early stages of being able to provide patients with electronic copies of their records. Personal health records are still not widely used, and many physicians would rather not pay the extra amount that vendors want to charge them for patient portals.
The Meaningful Use criteria are already pushing the industry in the right direction, and Stage 2 will move that trend further along. But this is an enormous industry with a lot of regional, cultural and technological variations, and no one should think that a federal ukase is going to create the connected world within a few years. The Health IT Policy Committee would be wise to look carefully at what's happening the field before it commits itself to a radical course in Meaningful Use Stage 3. - Ken