Promises not yet kept: Can health IT support healthcare quality?

An interesting convergence of articles flowed over my laptop recently:

1:  Becker’s ACS Review: The 11 things payers, providers really think about value-based care:^[1]

• Seventy-five percent of health plan executives believe EHRs have everything physicians need, while only 54 percent of physicians believe the EHR are properly equipped.
• Seventy percent of physicians do not see a link between EHRs and improved patient outcomes.

2:  Healthcare Informatics: OIG Report Estimates CMS Overpaid $729M in MU Payments ^[2]

• During a three-year span starting in 2011, the Centers for Medicare & Medicaid Services (CMS) overpaid an estimated $729 million in Medicare electronic health record (EHR) incentive payments to eligible professionals (EPs) who did not comply with federal meaningful use requirements, according to a report released this week from the Department of Health and Human Services’ Office of Inspector General (OIG).

3:  Healthcare Informatics, again: What Are the Potential Ripple Effects of the eClinicalWorks Settlement?^[3]

• On May 31, the U.S. Department of Justice announced a settlement that holds eClinicalWorks, and the company’s founders and executives—Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani—liable for payment of $155 million to resolve a False Claims Act lawsuit. The company allegedly violated federal law by misrepresenting the capabilities of its software and for allegedly paying kickbacks to certain customers in exchange for promoting its product, according to the Justice Department.

I’m pretty sure that most physicians and other health professionals would ascribe to the idea that health IT has yet to achieve a level of functionality that adequately supports their work.   Let me add one more article.

4:  New England Journal of Medicine: Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine. ^[4]

• A decade ago, a primary care physician I admired seemed to come undone. His efficiency had derived not from rushing between patients but from knowing them so well that his charting was effortless and fast. But suddenly he became distracted, losing his grip on the details of his patients' lives. He slumped around, shirt half-untucked, perpetually pulling a yellowed handkerchief from his pocket to wipe his perspiring forehead. Everyone worried he was sick. His problem, however, turned out to be the electronic health record (EHR).

As noted in the NEJM article, EMRs were developed to facilitate billing for services. Quality functionality lags, so health professionals spend a lot of extra time and effort working around inadequate technologies---time and effort that could have been spent serving their patients’ needs. 

We would all benefit from investment in technologies that paid more than lip service to delivering real functionality.  Support the workflow of clinicians.  For example: minimize the number of “clicks” and pull-down menus, let them quickly dictate or write notes in natural language and let technologies solve the problem of data capture through intelligent rules engines and natural language processing.

L. Gordon Moore, MD, is senior medical director for Populations and Payment Solutions at 3M Health Information Systems.

[1] Oliver, Eric. “The 11 Things Payers, Providers Really Think about Value-Based Care.” Becker’s ACS Review, June 13, 2017.

[2] Leventhal, Rajiv. “OIG Report Estimates CMS Overpaid $729M in MU Payments; How Concerning Are the Findings? | Healthcare Informatics Magazine | Health IT | Information Technology.” Accessed June 16, 2017.

[3] Landi, Heather.  “What Are the Potential Ripple Effects of the EClinicalWorks Settlement? | Healthcare Informatics Magazine | Health IT | Information Technology.” Accessed June 16, 2017.

[4] Rosenbaum, Lisa. “Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine.” New England Journal of Medicine 373, no. 17 (October 22, 2015): 1585–88.