When I first started using an electronic health record (EHR) almost 20 years ago, many policy makers misunderstood how EHRs worked. They assumed that care was somehow made better just by having an EHR, and thus began to build the case for policy aimed at supporting EHR adoption. Fortunately as the HITECH Act of 2009 makes clear, a maturation of thinking has occurred; it is not the mere presence of technology, but good technology used in meaningful ways that can improve care.
Magical thinking about EHRs has disappeared, but a similar irrational belief has taken its place– this time around the concept of interoperability, the ability of systems to communicate with each other. Today there are two widely held concerns about the current state of interoperability. The first concern is that the Meaningful Use program, the federal EHR incentive program created by the HITECH Act, was doomed from the outset because it did not begin with the requirement that EHRs be capable of communicating with each other.
The other is that while it was acceptable not to have required full interoperability at the outset; now it is the single most important task at hand. By this account, interoperability must be put on a fast track, because the American people will be unlikely to reap any benefits from health information technology without it. I strongly disagree with both of these positions.
First, if the Office of the National Coordinator for Health Information Technology (ONC) had conditioned the start of Stage 1 of Meaningful Use on full interoperability of EHRs, I believe that the already slow rate of EHR adoption would grind to a halt. Vendor development and purchase decisions would go on indefinite hold awaiting final interoperability specifications. But by moving forward with the status quo of partial interoperability, most providers, nurses, clinical, and nonclinical staff now have at least basic if not reasonably good health IT functionality and literacy. For example, the majority of prescriptions for non-controlled substances are now sent electronically — not a complete remedy for medication errors, but an important move away from those errors due to illegible handwriting. And more importantly, many tens of millions of patients have received (many for the first time) summaries of their health care visits and hospitalizations that provide a list of their active problems, medications, and medical allergies, not to mention written instructions.
Secondly, many providers and provider systems have gone ahead, even where interoperability is limited to laboratory data, with quality improvement programs that leverage their EHRs for analytics, point-of-care decision support, and patient education and engagement tools. As an example, in 2012 the Department of Health and Human Services and the Centers for Disease Control and Prevention, together with the American College of Cardiology and the American Heart Association launched Million Hearts® – a program of education, screening, and treatment – with an end point of preventing one million new heart attacks and strokes over 5 years.
Read the rest of this entry »