Guerra On Healthcare: Fast EMR Decisions, Poor Choices
The Meaningful Use program has forgotten how much must go into system selection and implementation; selecting the right system is the foundation upon which everything else is built.
In my last column, I wrote about the disconnect between the buzz at HIMSS and the actual work going on in the trenches of healthcare IT. This week, I'm going to continue with the theme of disconnects and focus on two specific ones brought to light by a recent KLAS report and the subsequent interview with its author.
Since I try to give insights every week, I've always got an ear out for those offered by others. As most of you know, I'm a KLAS fan, as their analysts are deeply immersed in the industry -- the only way one can absorb enough observations to yield true insights. Reading over the organization's most recent report on ambulatory EMRs, I came across the following under the subhead "HIE Naivete":
"Providers are buying and switching EMRs today because of MU dollars. One of the key components of the legislation is sharing patient information with other caregivers in the community. When asked about plans to meet this requirement, most providers had little to no awareness of the requirement, nor thoughts on how this would happen, or the costs involved."
The above quote dovetails perfectly with my feelings about how the vast majority of eligible providers (let's say, practices with less than 10 docs) are dealing with MU. That is to say, other than perhaps buying an EMR, I don't think most of them are dealing with it at all. While hospitals have IT departments and some level of resources to throw at the program, most docs are heads down seeing patient after patient, with little interest in pouring through pages of MU requirements, let alone figuring out how to meet and then report on them.
A second "wow" moment came during my interview with the report's author, Mark Wagner, KLAS director of ambulatory research, when he said the following:
"There's a real division between the providers who understand what they are doing and why they are doing it, and those who are doing it for other reasons -- such as to get the incentives, avoid the stick, whatever the reason is. There is a real distinction between those groups and a real division there and, if you look at the next wave of what comes as it relates to the adoption and longevity of these EMR solutions with practices, I think you're going to find that the group who goes into this with blinders on will end up being caught in the [replacement] cycle. We're going to see them come back through a second time -- hopefully not a third time. The folks who are planning well -- who are going through it carefully and having hard discussions with vendors -- those folks are best suited to be successful, not only going into MU and collecting those dollars, but also looking at some of the bigger goals and rewards that can come through this program. They probably won't come through the EMR adoption cycle again."
He continued: "Somehow, we've got to overcome this gap of people who don't know or just don't get it or aren't looking at it. We have to figure out how to get to them and make sure the first time they make the investment is the last time they have to. Providers see that $44,000 as a big chunk of money, but the reality is going to be that when they replace a system for the first time, they've given up that much money, plus some."
The Meaningful Use program has put so much pressure on "use" that it forgot how much must go into system selection and implementation. In their disdain for "merely buying a system," they forgot that selecting the right system is the foundation upon which everything else is built. To even come close to meeting the measures in the allotted time, selection and implementation must be done is what amounts to an instant. This is just one more way a general idea (HITECH) has been poorly operationalized by a cadre of bureaucrats and volunteers who will not be directly impacted by the program they've crafted.
As Wager said, many providers are coming through a second and even third time on their quest for the right EMR. The government is of the opinion that any movement of the market is good, but is taking one step forward and two back still moving in the right direction?