Meaningful Use- Rise of the “Best of Breed”?????

Is the “Meaningful Use” financial incentive actually going to end? According to article CMS Promises Meaningful Use Replacement This Year significant changes in the program will be implemented in 2016 and possibly be in effect by 2019. The goal is a more “patient-centered” output and not endless data collection.

Meaning full use was defined by the government to be

1. The use of a certified EHR in a meaningful manner.
2. The electronic exchange of health information to improve quality of health care.
3. Stimulate the adoption of EHR through financial incentives for using (e.g. not let it sit in the corner) certified EHR technology for defined elements of clinical care.

After 32 Billion Dollars expenditure in incentive money, we have a dysfunctional, non-intraoperative, and user-unfriendly national conglomeration of systems that just can’t communicate with one another.  Sounds a bit like Congress, does it not? The outcome probably should not be called a system because every product is somewhat unique and the stated goal of being able to trade information between facilities (interoperability) is no closer than it was in 2004 when then-President GW Bush put the federal government into the electronic record business.

Now, CMS has reset its sights, deciding that the new goal is not to promote adoption of EHR technology, but to pay providers for (good) outcomes that result from using such systems.  This paradigm, in CMS mind, is to replace the fee-for service paradigm. Of course! Why not!  For example, someone arrives in ventricular fibrillation and you pull out all stops to try to get the heart beating synchronously again.  Shock after shock fails.  Drugs fail. Everything fails. The patient succumbs. The outcome:  well, it is no-so-good. But you do not get paid for the powerhouse effort that you are describing on the EH R record.  No.  You write that the patient was transferred to the morgue.  Hence, the outcome deserves zero reimbursement.  Certainly much less than I you had restored cardiac rhythm and transferred to the CCU, before the patient died, and then was transferred to the morgue. Make sense?  Maybe CMS will convince hospitals to keep investing in better equipment, at least so it is ready one of the CMS administrators show up in v-fib.  Or maybe they will not, and the outcome will be vfb à morgue. 

Now, how this will be done will be interesting to watch. It will be quite challenging because certain specialties provide isolated real-time care while the traditional life-long practice provides longitudinal care. For most of the latter, the patient is still present when outcome is determined. The reconciliation of these different, and somewhat competing, paradigms will be difficult to achieve.

The Electronic Health Record, so often written about in many of our prior blogs, will need to change its fundamental character.  An emphasis on creating legally defensible documents, and an emphasis on an EHR use as a billing tool, will both be expected to come in secondary to its use as a patient-centered tool.

It’ll be nice if it works.  No skeptics here, right?  Yet, the coming evolution of the EHR may present great opportunities for focused or “Best of Breed” electronic health records that handle specific medical areas of expertise. Yes, enterprise systems will continue, but they may be constructed as user specific modules (apps) to accomplish these new goals. Think of your cell phone. These systems will have to allow “plug and play” programs or specific “apps” to give the providers the necessary support to be efficient and financially successful.