The Importance of IT Staff in a Rapid Shift to EHR
The Centers for Medicare and Medicaid Services (CMS) Meaningful Use requirements have spurred a rapid transition from paper-based medical records to electronic health record (EHR) systems in less than 10 years. Today, many providers use EHRs and are working on meeting the program’s new emphasis on interoperability, or ensuring that a care provider’s systems can work together easily.
IT professionals have been at the heart of the EHR revolution since the beginning, and they continue to play an essential role in helping healthcare providers communicate effectively to improve patient care. IT staff play a key role in making EHR use truly meaningful for both providers and patients.
As the program shifts its focus to interoperability, Meaningful Use continues to change the way health IT concerns are raised, analyzed and addressed.
What Is Meaningful Use?
Meaningful Use is the colloquial name for a set of requirements for the use of electronic health record systems emphasized by the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act). The goal of the HITECH Act was to improve the rate at which US healthcare providers adopted workable systems of electronic health record use.
The HITECH Act also authorized $36 billion in payments to incentivize healthcare providers to switch to electronic records, says Maulik P. Purohit, MD, a member of the HIMSS board of directors. The EHR Incentive Program provided additional payments to eligible providers, hospitals and critical access hospitals when they met the program’s standards for the meaningful use of EHRs within their respective care settings. The program established a three-stage process to meet this goal:
- Stage 1 (2011): Use of certified electronic health record technology (CEHRT) to collect and share data.
- Stage 2 (2014): Use of CEHRT to advance clinical processes.
- Stage 3 (2017): Use of CEHRT to improve health outcomes.
In 2018, providers participating in the EHR Incentive Program could choose whether to work on Stage 2 or Stage 3 objectives. Starting with the 2019 reporting year, all providers participating in the EHR Incentive Program will be expected to focus on Stage 3 requirements.
According to the American Academy of Pediatrics, focusing on Stage 3 by 2019 means that in the coming years healthcare providers will be working on projects like improving privacy and security for protected health information; making information easily accessible to patients; and using computer systems to submit all orders, referrals and prescriptions
The Focus on Interoperability
In 2018, CMS rebranded the EHR Incentive Program. The program’s new name, “Promoting Interoperability,” is intended to focus on de-siloing medical data and streamlining operations, says Jennifer Bresnick at Health IT Analytics.
“Not only is the idea of required EHR use not dead, but it is changing and potentially expanding,” says Josh Mast at Cerner. Proposed changes for 2019 and 2020 include updated measures for success and demands for prescription-drug monitoring, updated electronic communication with pharmacies, and improved data tracking. It also requires better electronic communication in the patient-referral process in an effort to streamline how patient data is moved from the referring physician to the specialist.
Has Meaningful Use Changed Healthcare?
Several healthcare providers have reported improved outcomes for patients with the successful implementation of healthcare IT systems that include EHRs and patient portals. For instance, using an EHR in solo practice improved the provider’s ability to care for patients more efficiently, remind patients of follow-up care and make referrals, says J. Wellington Adams, MD.
In one Rhode Island primary care practice, seven physicians found that their ability to meet patients’ needs improved with their adoption of an EHR beginning in 2005. “We developed a system that provides flexibility for providers, yet preserves structured data that is integral to clinical decision making,” says David Gorelick, MD, the physician in charge of the practice’s EHR implementation.
As a result, each physician was able to provide the individualized care their respective patients needed and had come to trust. At the same time, the physicians could standardize their data, which helped the whole practice improve its quality and consistency of care.
Bumps Along the Way
Not everything has gone smoothly, however. Usability issues in EHRs have the potential to cause actual harm to patients, according to a study by Jessica L. Howe and fellow researchers published in the “Journal of the American Medical Association” (JAMA).
The study examined patient safety reports from 571 Pennsylvania healthcare facilities. It found that while the overall risk of patient harm linked directly to EHR use was relatively small, events that did occur could often be linked to the usability — or lack thereof — of the EHR system.
For instance, data entry challenges contributed to 27 percent of reported patient harm events, while interoperability failures contributed to 18 percent. Usability challenges also negatively affected order placement, medication administration, reviews of lab results and documentation.
The Future of Meaningful Use: How Clinical Staff Can Prepare
The modifications to the Meaningful Use program made in its resurrection as “Promoting Interoperability” represented a victory for providers who were struggling to meet the original program’s ambitious goals and timeline, says Robert Tennant, director of health information technology policy for the Medical Group Management Association (MGMA). Tennant hopes the change indicates Washington’s renewed interest in the success of implementing EHRs nationwide.
For developers and IT professionals, implementing the changes effectively may continue to be a struggle. While the technology itself appears to be well-understood, connecting its operation and use to the interests and needs of leadership, clinicians and patients continues to create a challenge.
Below are three things clinical staff can do to implement EHRs within the scope of the revamped Meaningful Use program.
Get Buy-In From Leadership
Although the CMS set aside billions of dollars in incentives for EHR use, many healthcare providers have continued to see EHRs as a problem for IT staff. Healthcare systems whose leaders understand the importance of their own involvement in Meaningful Use/Promoting Interoperability are few and far between, says Doug Thompson, a senior research director for the Advisory Board’s health IT suite.
Buy-in from leadership is essential to building an effective EHR system — as one Georgia health system discovered in 2014 when its attempt to establish a new system collapsed due to a lack of communication at the administrative level coupled with a lack of training. James L. Moore, then the center’s senior vice president and chief medical officer, noted at the time that more input from clinicians could have helped improve the rollout.
“A common issue is gaining buy-in from key stakeholders and building a common understanding of the reason the institution is devoting so much effort to the undertaking,” says Michael Abrams, a managing partner at Numerof & Associates. IT staff can play an important role in this process by translating technical requirements into plain-language terms, helping stakeholders understand how much time the effort will take, what changes it will demand from stakeholders and what success will look like.
Communication is arguably even more important in Stage 3, when interoperability between systems takes center stage. That’s why IT staff must share information clearly and regularly with all stakeholders to ensure the project’s success.
Teaching Providers to Use Systems Effectively
Clinical IT staff will need to improve their ability to teach medical staff and other stakeholders how to use software.
Early work on Meaningful Use saw a drop in productivity among many providers who faced a steep learning curve with the software, as Mark Thornton, MD noted in 2012. Six years later, medical students and residents face the same struggles, as medical schools do not currently prepare students to use EHR systems in practice, says Brendan Murphy with the American Medical Association. Because Stage 3 demands improved interoperability, providers may face another learning curve as they familiarize themselves with new systems for making referrals, entering orders or writing prescriptions.
This is something a tech partner can help with, especially during the initial stages of implementing a new tool. The tech partner’s experience can make onboarding a smoother experience, and most solutions can be customized to fit in with a clinic’s unique workflows.
Understanding the Patient’s Perspective
A key component of Stage 3 compliance is to ensure meaningful patient access to personalized medical information via electronic means. Since this access can also improve patient satisfaction, providers and their IT teams have two significant incentives to get Stage 3 implementation right.
One way to embrace patients’ perspectives during the Stage 3 process is to work with executives and other stakeholders to engage with patients directly. Engaging focus groups, taking surveys and gathering similar input helps providers ensure that patients can effectively use patient portals to engage with their own health information, says Bruce Henderson, director and national leader of the EHR and health information exchange practice at PwC.
This is where a reliable tech partner could come in handy. The right partner would have an intuitive understanding of the patient perspective, and could then design solutions that would help improve patient satisfaction and leverage available technology to its fullest.
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