Page 10 - Volume 69 Number 3
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I Have Something To Say Part Two
By Richard E. Burney, MD
The Electronic Health Record – How It Went Off Track
Part I of this essay recounted the journey from the early days of computing to development of the first homegrown electronic health record (EHR) and called attention to some of the advantages and problems that came with it. I wrote that things were about to change dramatically, and
they did as electronic health data collection became an increasingly essential, mandatory and confusing aspect of health care delivery.
By the start of the new millen-
nium, Health Information Technol-
ogy (or HIT) in one form or another
had begun to replace the paper-
based medical record in many if not
most large hospitals. There was
simply too much information going
into the chart to be managed any
other way. It was about the same time that the Information Technology (IT) industry began its ascendancy as a big player in the medical-industri- al complex. IT companies developed a more comprehensive, integrated, multipurpose electron- ic health record while promoting it as a solution to the biggest, most vexing problems and challenges in health care: the EHR would lead the way to improved health care quality at lower cost.
The IT industry did a good sales job, because their promises were soon translated into the Health Information Technology for Economic and Clinical Health Act, or HITECH, which was passed as part of the American Recovery and Reinvestment Act
of 2009, at the height of the economic collapse of 2008-2009. HITECH made available an enormous amount of money, $27 billion over 10 years, to promote the adoption of EHR systems nation-wide, something the Center for Medicare and Medicaid Services (CMS) saw as essential to delivering the right care at the right time to the right patients.
In the beginning the program provided small monetary incentives for physicians as a motivation for them to acquire and use EHR technology. There was an important reason for this and also a catch: The reason was that the EHR technology would enable the electronic collection of enormous amounts of health care delivery data; the catch was that HITECH tied payment to the demonstration of
advances in health care processes and outcomes
– in other words, the money would only come if meaningful use could be demonstrated. Through the mechanism of meaningful use, the EHR could not only potentially provide insights into how care was actually being delivered, it could also theoretically help ameliorate huge health problems
such as smoking, obesity, depression and low back pain.
The EHR Incentive Program in
the Beginning
The initial plan was to make it so easy for physicians to comply with the meaningful use mandate that anyone could do it and no one would be scared away, while also making it pretty easy for the IT companies. The first meaningful use objectives,
promulgated by CMS in 2010, were surprisingly elementary. For example, one objective for an
EHR was to have the capability to record patient demographics and vital signs. Another was the capability to record the patient’s problem list and current medications; also height and weight, and smoking status. A more challenging task was to implement computer provider order entry and electronic prescribing. The data in all cases had to be “structured,” that is, organized in such a way that the information could be easily aggregated and analyzed – and therefore usable at some time in the future for assessing health care delivery and directing (and measuring) improvement.
The most direct and annoying result of the EHR Incentive Program (as it was called) mandate to demonstrate meaningful use is that when I sit in an exam room with a patient, I now have to record (by mouse click) that I have reviewed the problem list, the current medication list, and smoking status, and vital signs, etc., on each and every patient visit, regardless of its purpose. Even if it’s for a simple post-op suture removal, the computer reminds me to verify that I have done these things required for “meaningful use” in order to assure that my institution (or office, or group) is going to be in full compliance with meaningful use requirements.
The visit documentation for my patient is not complete until I have completed these steps,
10 Washtenaw County Medical Society BULLETIN JULY / AUGUST / SEPTEMBER 2017

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