Really? Meaningful Use Did Not Work?

There is a new study in the Journal of the American Medical Informatics Association that contends the electronic health records meaningful use program did little to accelerate physician adoption of electronic health records.

At best, EHR adoption may have increased 7 percent above the level predicted in the absence of meaningful use and its subsidy payments to physicians, and at worst the rise could have been no more than about 1.5 percent.

The study was conducted by four researchers at three major university schools of public health; I shall not contest their knowledge of healthcare or the meaningful use program. And the study is very dense, confusing and, like many such studies, is only marginally understandable to laypersons.

But this layperson believes the study is wrong because common sense—which should always be on a level somewhat akin to advanced academic knowledge—suggests it is wrong. The authors blew me away with statistics and analyses I did not fully comprehend—I’ll give them that. But some of their data was pretty old, and I have a couple statistics they missed.

The HITECH Act was enacted in 2009, implemented during 2010 and Stage 1 of meaningful use became real in 2011. During 2011, 123,648 eligible physicians registered for the Medicare meaningful use program, and 49,051 registered for the Medicaid meaningful use program. In 2012, another 113,658 Medicare EPs and 61,098 Medicaid EPs registered. This doesn’t even count the 4,224 hospitals that registered in those two years.

Can anyone imagine that rate of EHR adoption or movement to adoption would have happened absent the meaningful use program? If the meaningful use program wasn’t inducing adoption, what was the impetus? Study authors note that some physicians were induced to adopt EHRs because other doctors in their region were doing so and maybe they could exchange data, and some may have adopted because they like to keep up with changes in technology.

No. Doctors adopted on a fast-track because meaningful use was a government mandate that included subsidies for participating and financial penalties for non-compliance. Some things are that simple.

The meaningful use program was specifically designed and implemented to support the Affordable Care Act which was to come. In 2009, EHR adoption was abysmal. The Obama Administration was getting ready to run through the ACA program and needed to light a fire under the industry to automate. And they did.

Think about how much the ACA—still a very young program—has changed the industry in just a few years and how much ACA is dependent on EHRs as well as data analytics, which get much of the richest data from EHRs. Think about the need for EHRs and analytics to support population health management. Think of the torturous trek to health information exchange that also was part of meaningful use and ACA, even if the promise of HIE remains quite unseen yet. None of this happened by accident; it was the government’s plan.

To their credit, the study’s authors acknowledge multiple deficiencies in methodologies, which is common if for no other reason than researchers rarely get to play with the most recent data, and they state that “more work is needed to better understand the dynamics of physician adoption patterns.” On that, I wholeheartedly agree.