Halamka: Meaningful Use has run its course

The move to outcomes-based models offers a chance to increase usability for professionals.

____simple_html_dom__voku__html_wrapper____>Never one to mince words, John Halamka, MD, CIO of Boston’s Beth Israel Deaconess Medical Center issued a wide-ranging call to action for healthcare information technology, including electronic health records, big data and analytics, cloud and mobility solutions.

Delivering the opening address at a pre-conference symposium entitled “Are We There Yet? Health Information Technology’s Report Card,” Halamka declared that the Meaningful Use program has “run its course” and that the healthcare industry must move away from the EHR Incentive Programs to outcomes based payment models for clinicians and hospitals while embracing new reimbursement approaches.

While EHRs had been “perfectly engineered” to meet regulatory requirements, he evaluated the performance of these systems to date giving them a C+ grade overall. The problem, according to Halamka, is that in order for a clinician to get through a patient encounter and be Meaningful Use Stage 2 compliant they must enter 141 structured data elements to calculate electronic quality measures that “probably aren’t going to be used.”

When it comes to EHRs, he asserted that “we need to look at what we’ve done to ourselves” in terms of efficiency, workflow, and physician satisfaction and soberly assess whether the healthcare industry is able to achieve the outcomes that these systems were meant to enable—better care coordination.

“We need everyone to work at the top of their license, and clinicians {working) as data entry clerks is not the top of their license,” Halamka said. “You have 12 minutes to see the patient, 140 structured data elements to enter, you have to of course never commit malpractice, and make eye contact. It’s not possible.”

Despite the fact that more than three-quarters of U.S. hospitals and half of outpatient practices have installed EHR systems, Halamka lamented the fact that 40 percent of physicians feel burned out. “Look at Meaningful Use Stages 1, 2 and 3; it’s as if we’ve been running a marathon every day for the last seven or eight years, and we are tired,” he said. “We must reduce clinician burden.”

Further, Halamka charged that health IT certification in its current form paralyzes innovation and does not improve interoperability. What’s needed, he said, are a national provider directory, a voluntary national patient identifier, a trust fabric, a governance framework and consistent privacy policies.

“Meaningful Use was very important in its day, Moving us to at least a floor of functionality, Stage 1 was good."“Meaningful Use was very important in its day,” Halamka contends. “Moving us to at least a floor of functionality, Stage 1 was good. The problem is we tried to move too far, too fast before we had the cultural change or the enablers like a patient identifier, the provider directory or trust fabric.”

At the same time, he advised that it’s time to return innovation to the private sector, noting that he doesn’t blame EHR vendors for the shortcomings of these systems. “It’s not that the vendors delivered bad products or unusable products. It was that we demanded them have to have certain functions, and that created a level of stress and lack of usability and suitability of purpose,” Halamka told the HIMSS audience. “If you were to coordinate team-based care between the primary care provider, a specialist, patient and family, inpatient/outpatient, urgent care, would it be easier in your EHR or Facebook? Most people actually say Facebook.”

A secure Facebook-like social networking application would be better than EHRs for bringing together patients, families and physicians, Halamka reported that he told the Centers for Medicare and Medicaid Services. The response from CMS, he said, was that it would “violate 300,000 pages of regulations.” As a workaround, Halamka countered that doctors, “at the end of the day, could cut and paste the Facebook entries and insert them into the EHR.”

According to Halamka, 80 percent of Beth Israel Deaconess Medical Center’s public-facing assets such as PHRs, websites and social media are accessed on mobile devices. “The desktop is dead,” he opined. “This is the way patients and families want to navigate their care, using middleware on their smartphones to gather the data to push it to and from the doctor.”

As an example, Halamka referenced an initiative at Beth Israel Deaconess Medical Center called MyICU, a new communication tool designed for ICU patients and their families that takes raw health data and presents it in a dashboard on iPads.

“I actually do feel better about patient and family engagement,” he commented, giving the technology category a B grade. “I look at all the major vendors and their PHRs and the fact that if patients want to get to them, they can.”

Similarly, Halamka gave B grades to big data/analytics as well as mobile/cloud applications. “The big challenge with mobile and cloud are the lawyers,” whom he said tend to be wary of the risks involved and are fearful that systems might be compromised or go down. Nonetheless, Halamka believes that outsourcing to the cloud actually reduces risk through system redundancy offered by commercial public providers. “Risk can never be zero but we’re heading in the right direction,” he asserted.

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