The Health Information Technology for Economic and Clinical Health (HITECH Act) has significant implications for how healthcare organizations (particularly small healthcare clinics) conduct and transact business. President Barack Obama signed this act into law in February 2009 as an extension of the American Recovery and Reinvestment Act of 2009 (which functioned primarily as an economic stimulus bill).
In layman’s terms, this bill incentivized healthcare clinics and hospitals to go paperless through EMR (Electronic Medical Record) or EHR (Electronic Health Record) technology. The bill stipulates that ‘meaningful use’ can be parsed into 3 stages as they are written by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT. Incentives were provided to clinics and other healthcare organizations based on the degree of ‘meaningful use’ attained through these EMRs/EHRs as described below:
- Stage 3 Meaningful Use: The most advanced of meaningful use stages in the act, many tenets of this form of usage remain a mystery: However, it is likely to follow the same format as its predecessors, dividing requirements into mandatory and optional camps.
- Stage 2 Meaningful Use: Demands a certain number of transactions be processed electronically, and adding lab results to digital recordkeeping.
- Stage 1 Meaningful Use: The most detailed of the meaningful use stages, this stage contains 25 total criteria comprised by 15 core requirements and 10 ‘menu’ requirements. The core requirements are compulsory, whereas clinicians and healthcare providers can choose 5 of the 10 requirements from the menu to meet by their own accord.
A report to United States Congress in 2014 noted that significant progress had been made in the adoption and use of EHRs/EMRs among small clinics and other healthcare practices. This progress was measured by the fact that three-quarters of eligible professionals and nine in ten eligible hospitals had received subsidies from Medicare and Medicaid in EMR incentives.
This is where we start asking questions, and here’s why:
Nobody can argue with ‘meaningful use’ being a good indicator of the Act’s progress, but are healthcare practitioners being incentivized to meaningfully use the right technology, or is there a better technological option to begin with?
These quotes from healthcare providers are a good starting point for proving why EMRs and EHRs aren’t the best technology to fulfill the standards set forth by the HITECH Act:
“Initially you drop about 30 percent of productivity following an EHR implementation, sometimes more. You recover a little bit, but you never regain your total productivity.” (1)
- John Rogers, MD. Fairview Park Hospital, Dublin, Georgia
“It’s very easy to record large amounts of data and click-off boxes. So the emphasis is really on data collection, but what physicians ought to be doing is data synthesis. They ought to be taking that data, putting it together and coming up with a differential diagnosis and then figuring out what the best diagnosis is and then the best treatment. That has been lost in just five short years of using these products.” (1)
- Gary Botstein, MD. Dekalb Medical, Decatur, Georgia
“It’s been a nightmare for us. Because of the way these meaningful use requirements are set out there isn’t really a patient portal that is efficient. Our patients hate the patient portal we use and we’ve used two different patient portals (both of which are EMRs). They just think it’s very inefficient.” (1)
- Steven Wertheim, MD.
If you’re a clinician, read more about the alternatives to this problem today.