Does Meaningful Use Inspire Innovative or Mediocre Systems?

I was absolutely intrigued by Dr. Webster’s tweet about the impact of meaningful use (MU) and the types of systems it inspires. I think everyone would agree that MU has done nothing to inspire innovative EHR systems to be created and I think most would agree that it’s mostly fostered the creation of mediocre systems.

I’m not saying that meaningful use has no redeeming qualities. It definitely drove adoption of EHR software. Some of the meaningful use requirements like ePrescribing and CPOE were already moving forward for many organizations and meaningful use threw gas on those fires. I think those will turn out to be really beneficial components to meaningful use.

We could talk about the overall impact of MU (good or bad), but I’m not sure how productive of a conversation that would be. Meaningful Use is the reality of today. So, instead of focusing backwards on something we can’t change, I’m interested to think about what meaningful use could become. For all intents and purposes, that’s going to be called meaningful use stage 3 (unless ONC decides to spend time on a rebranding).

The key question: Could Meaningful Use inspire innovative EHRs and other innovative health IT?

While I’m skeptical of government regulation doing much for innovation, I think there’s a chance that this could happen. The key change will be that meaningful use needs to move away from its prescriptive approach and requirements. Innovation rarely comes from prescriptive approaches to anything.

Instead of being so prescriptive, meaningful use should focus on creating frameworks for which innovation can happen. My initial analysis of FHIR is that this is directionally right when it comes to inspiring innovation in healthcare IT. I need to dig into the details a bit more, but the concepts of creating an open framework for health IT companies to innovate on top of EHR data is what things like meaningful use should incentivize. Reimbursement should help to encourage this type of innovation. HIPAA should be clarified to support this type of innovation.

RHIR is just one example and I’m sure there are many others. It’s an open approach which encourages the right things while not damaging those for which it doesn’t make any sense. To me that’s the major difference between a prescriptive requirements list versus a framework oriented approach.

Do we really care that doctors game the system to be able to meet the 5% patient engagement requirement of meaningful use? What value does that provide the healthcare system if they’re not truly engaging? That’s too prescriptive. I’m all for patient engagement. Doctors are too. However, these prescriptive MU requirements just cause doctors to game the system as opposed to truly engage.

What do you think could be done with MU so that it inspires innovative EHRs instead of mediocre systems?

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

7 Comments

  • As tempting as it is to blame the government (and the tens of billions of dollars it contributed…albeit with strings) on the current (rather uninspiring) state of health IT, the real culprit is the healthcare organizations that made the decisions to buy – of course with federal bri…er..incentives – the same mediocre systems that few bought before the program.

    The fundamental mistake of the meaningful use program was the assumption that the health IT industry would respond to the timelines, incentives, focus on new care models and investments with rapid innovation and commitment to open standards. The reality was that the health IT’s most well-heeled players sought every effort to shape meaningful use requirements in ways that suited them (vs. new entrants / innovative upstarts). The aggressive timelines of the program ensured that the illusory “success” of both ONC and health systems was dependent on rapid purchase and adoption of the last generation (“proven”) systems that will hang like an albatross around the necks of healthcare systems for years to come.

    Ron

  • Hi Ron,

    More specifically (since my tweet above was quoting someone else), I blame government and healthcare organizations for failing to adopt workflow tech that has been around for decades in other industries.

    Even after healthcare and government organizations smarten up, even after we connect applications so they can speak to each other, we won’t have good ways to tell them what, when, and how. We’ve no ways to represent (and edit and improve) healthcare workflow so it can be designed and executed without need for programmers who don’t understand it. Today, ‘workflow’ is spread throughout the relatively hardcoded implementation code of every EHR and HIT application involved in this workflow.

    EHR and HIT-mediated interactions, inside hospitals and clinics and outside with patients and payers, are fragile, prone to ambiguity, don’t cross organizational boundaries well, and scale badly. The more we automate healthcare workflow with current non-process-aware technology and the more participants who join the fray, the more frozen healthcare workflow becomes and the harder it is to propagate change and new players into these workflows.

    One of the advantages of process-aware BPM-style health information systems and EHRs, is they can be quickly adapted to changing incentives and regulations. Even if we change healthcare’s incentives and business models tomorrow, current EHR and HIT systems cannot easily be adapted into newly optimized configurations and workflows. We are cementing into place frozen workflows that will resist systematic improvement for years to come.

    As my wife says: “There’s plenty of blame cake for everyone!

    Thankfully, finally, and partially driven by the failure of billions of dollars of workflow-oblivious health IT systems, I’m seeing hopeful signs that executable models of work and workflow are rapidly diffusing into health IT and digital health.

    As I see it, there are three related activities that will even further accelerate these hopeful trends.

    1. Educate EHR users and HIT buyers so they can recognize systems with the more customizable workflows.

    2. Find and market the EHR and HIT vendors with the right stuff: workflow engines, process definitions, graphical editors, plus other valuable BPM-like and -compatible products and services.

    3. Leverage existing business process management and adaptive case management vendor products and services.

    As I tweeted yesterday:

    “#HIMSS15 gonna be interesting. Soo … much workflow tech flying under radar, at some point it’s gonna spill over into popular consciousness”

    –Chuck

    PS Hey John, am I predictable or what? 🙂

  • Ron,
    “the last generation (“proven”) systems that will hang like an albatross around the necks of healthcare systems for years to come.”

    This is my fear as well.

    Chuck,
    You’re quite predictable. This sentiment harkens to Ron’s as well: “We are cementing into place frozen workflows that will resist systematic improvement for years to come.”

    I’d ask you Chuck if you think that any of the current EHR systems can make changes to their software such that they can become workflow based EHR or will it take a new EHR to achieve this goal?

  • Good question John.

    Meaningful use hijacked EHR software development. Most certified EHRs are now workflow-oblivious clones. However, some EHRs with customizable workflow may have survived. It’ll take a while for them to distinguish themselves in the market, as MU wanes. A few years ago I created the Electronic Health Record
    Workflow Management Systems
    Features & Functions Survey

    http://chuckwebster.com/survey-ehr-workflow-management-system-features-functions

    and published it under a Creative Commons Attribution 3.0 License. I’d love to see someone take it seriously, and use it to score some points against the workflow-oblivious EHRs currently plaguing EHR users.

    On the other hand, MU created a multi-billion dollar market for software to compensate for EHR inadequacies. Speech recognition, mobile interfaces, Google Glass startups, care coordination and patient engagement platforms, etc., all treat (or try to treat) EHRs like mere databases (believe you wrote a post about this trend a couple years ago). Guess what’s the most important secret sauce under their hoods?

    Workflow tech.

    We’ll probably see a bit of both (EHRs and EHR workarounds), especially as current low-level interoperability initiatives hit walls and run out of steam. What’s missing, that is most direly needed, is not transport (syntactic interoperability) and translation (semantic interoperability. It’s pragmatic interoperability, the ability to explain why you got a message. Why did they send it to me? What are they trying to achieve? How can I help them do that? If I can’t, how can I still be helpful? Pragmatic interoperability is about not just getting and translating a clinical message, it’s about doing the right thing with the message.

    I’m not talking about some highfaluting artificially intelligent EHR. I’m talking about representing and reasoning about goals and tasks. This is exactly what workflow tech does, and it’s been around in other industries for literally decades.

    EHRs called EHRs vs non-EHRs avoiding being called EHRs? Which will succeed? Whichever can best and quickest bring pragmatic workflow interoperability to healthcare, will prosper. Those that cannot will eventually falter and gradually disappear.

  • Chuck – MU only hi-jacked EHR development because the decision-makers at healthcare organizations bought the cream of last generation’s crap.

    How many health systems went against the grain and said, “Eventual penalties and small-potatoes incentive payments be damned, we’re going to invest in something that can actually improve productivity and better support patient care vs. the crap that everyone else is implementing!”?

    Or organized to vocally change the direction of MU? It’s not as if every decision made in the program hasn’t had ample opportunity for public comment and input from the health IT stakeholders.

    Even those who had developed their own – arguably better, more sophisticated – systems are in the process of switching to either Epic or Cerner.

    Just as the people get the government that they elect, we get the MU program that we support. And – sadly – the healthcare establishment has voted with their dollars (or more correctly our tax dollars) to invest billions in exactly the opposite of what you describe, Chuck.

    What’s really crazy is that given the same choice, the DoD and VHA will likely make the same mistake.

    Ron

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