After a long couple of weeks on the road, I sat down in my window seat and closed my eyes for a quick flight back to Madison. It was then that the familiar urge from my pocket beckoned me to check my notifications.
Just as the cabin was secured and airplane mode was demanded, I found this question on Quora. Bad move. By the time we were at cruising my brow was already furrowed with specs of my reply. Here it goes:
How will the end of federal financial incentives affect EHR adoption in the US?
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Meaningful Use (the program in question) has played a substantial role in the widespread adoption of EHR technology. The ONC estimates that over 90 percent of hospitals and providers now use some sort of EHR. It’s clear that the industry is saturated and the only docs left holding clipboards are laggards.
The program has absolutely contributed to the adoption of EHRs. However, much of the criticisms to the policy surround the program’s effectiveness in delivering the improved care quality and efficiency anticipated by the technology.
Meaningful Use only saw two of its planned three stages go into implementation.
In simplified terms:
1. the first stage incentivized implementation of the specified technology,
2. the second stage tied metrics to how the technology was being used,
3. the third stage was to focus on measuring outcomes.
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In Andy Slavvit’s brief and unplanned mention of retiring the program earlier this month, he foreshadowed the ways that it would live on in other policy. He cited new programs that will focus more on outcomes and less on prescribing the means to get there. Additionally, he vowed to “level the playing field for startups” by mandating open APIs that allow new applications to easily and securely share data. This focus on outcomes and interoperability was core to the proposed MU Stage 3 measures.
This seemingly fruitless transition in the final stage of a program so fraught with grief is more likely a rebranding under new leadership. In its short-lived era, the term Meaningful Use has become a battle cry for policy opponents who frequently referred to it as “Meaningless Use” or “Meaningful Abuse”. (You may also remember my illustrated book on the matter.) The term became something in and of itself and distracted from its intended purpose.
The alleged demise of the program will have little impact on the continued adoption of the technology. Additionally, its absence will not suddenly cause providers and hospitals to revert back to the paper age. Switching costs are too high and the industry consensus is that it was a good idea to digitize healthcare. But how are we going to derive value from the effort? The bigger impact this will have on EHR vendors’ ability to deliver value from their technology is still unknown.
For the better part of the past decade these vendors prioritized new features and enhancements based on what the government mandated and what the market demanded, respectively. Through new reimbursement methods and quality measures focusing on outcomes (as opposed to actions) we’re seeing the largest health systems turn away from their sluggish EHR partners for answers. They’re hoping to find the necessary technology innovations in the startup space and are shifting funds to depend on incubators, accelerators, VCs, and new “Chief Innovation Officers” to help find signals in the noise. This evolution is already putting pressure on EHR vendors to more freely interoperate with other applications that hope to enhance and/or replace some of the out-of-the-box EHR workflows and functionality. This inevitably burdens vendors to be more innovative themselves: all good things.
As Meaningful Use was beginning to shift to the meaning (rather than “use” part) of its charter, the term will be replaced by new payment models, quality measures, market forces, and interoperability requirements that will undoubtedly keep EHR vendors busy in the years to come. They are, and will continue to be, the technology backbone of our health systems. Their fight, however, is in continuing to be much more than that.
Niko Skievaski is a co-founder of Redox, a modern API layer for EHR integration. Before Redox, he co-founded a coworking space and business incubator in Madison that attracts fellow former-Epic employees interested in startups.
Photo: Flickr
Niko Skievaski is a co-founder of Redox, a modern API layer for EHR integration. Before Redox, he co-founded a coworking space and business incubator in Madison that attracts fellow former-Epic employees interested in startups.
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