Working Out the Kinks in Health IT

Industry executives and government officials convened in Washington DC yesterday to examine the present state of health information technology (HIT), and to identify the bugs, challenges and hiccups that continue to plague EHR platforms, and the policies that regulate them.

“Doctor’s don’t hate technology, they hate bad technology,” said Shane Kennedy, managing director, digital, at Sudler & Hennessey, kicking off the Health IT Meaningful Usability Summit yesterday. “Bad” is a highly subjective term; it doesn’t mean the same to a three-year old as it did to Michael Jackson, for example.

Despite the fact that the Affordable Care Act “depends on programs that manage information better” to control wasteful spending, as Joel White, executive director at Health IT Now, an HIT advocacy and lobbying group, said in his introduction, there are still major obstacles to implementation. Physicians themselves are pretty high up on the list of those obstacles.

There are reasons (some of which are bad) for the slowdown in electronic health record (EHR) implementation among physicians, despite CMS’s ‘Meaningful Use’ incentive program, which pays physicians to adopt electronic record-keeping in a meaningful way. The Office of the National Coordinator (ONC) under HHS plays the role of “defining what the technology needs to be capable of doing” in order to qualify for meaningful use,” explained Jacob Reider, acting chief medical officer at ONC, in his TED talks-inspired presentation. Final rules for the second stage of the meaningful use program were finalized in late August; Reider said the emphasis with stage two is “user-centered design.” While some doctors complain that data input into EHR systems takes too long, throwing a monkey wrench into their workflow, Reider emphasized the importance of slowing down in the context of patient safety.

If a patient is scheduled to receive an amputation, in Reider’s example, do we really want a drop-down menu for left arm or right arm in the EHR, versus having a doctor type out the instructions by hand? “Good design guides us to do what’s right without thinking too hard,” said Reider.

While ONC must strike a balance in promulgating rules that don’t overburden physicians, but that still move usability forward, some groups would liked to have seen ONC set a higher bar for patient engagement in stage two. Eva Powell, director, health information technology programs at the National Partnership for Women & Families, told summit attendees that “patients and caregivers want to be equal partners in care…they need access to information.” The ONC rules for stage two – which will commence in 2014 for those early adopters who’ve achieved meaningful use in 2011 or 2012 – require that at least 5% of a physician’s patients be able to view, download, and transmit their electronic health records online. “The bar is very low,” said Powell. “A patient’s priority in terms of what they want [with respect to treatment and medical intervention] is every bit as material as the latest evidence-based outcome.”

It being National Health IT Week in Washington, US House Rep. Phil Gingrey (R-GA), an OB/GYN and co-chair of the GOP Doctors Caucus, stopped in to express his support for EHRs, despite the fact that “lots of doctors aren’t happy with EHRs…they don’t want ‘em. There are physicians on the hill this week protesting meaningful use.” In response to an EHR vender asking exactly what could be done to help government drive adoption levels and support of EHRs among physicians, Rep. Gingrey said the equivalent of you tell me, suggesting that industry should answer the question, not Congress.

It’s unclear at this point exactly what effect widespread adoption of EHRs would have on pharmaceutical drug sales; at this point, it hasn’t even been proven that EHRs would promote safer use of medicines. “The current literature is inconclusive regarding the overall impact of health IT and patient safety,” said Don Detmer, medical director, American College of Surgeons, and Committee on Patient Safety and HIT at the Institute of Medicine. What is needed at the macro level, according to Detmer and others, is a larger and more sophisticated “sociotechnical” system, of which HIT is merely a component.

The problem isn’t that EHR technology is all bad, it’s that physicians have drastically different workflows and needs, and patient interaction in the context of EHRs only complicates thing further. It would appear that market forces alone have not sufficiently addressed these issues. Maybe Apple, which announced its iPhone 5 today, needs to get into the HIT game.