The reelection of President Barack Obama won’t change the intricate realities underway in the trenches as physicians and practices perform the difficult task of replacing paper with electronic health records (EHRs).
While the election outcome means that the Patient Protection and Affordable Care Act (ACA) will move forward, health IT adoption, on which health reform depends, has thus far continued apace, no matter who was going to become president.
The deployment of EHRs and their meaningful use are progressing, driven faster by the potential for federal incentives to help offset provider investment, but the process toward digitizing health care, like other industries before it, faces the strains and disruptions of maturing technologies.
[Political Malpractice commentary: Don't pop the champagne for ACA anytime soon]
The outcome of the election was not the issue because the real revolution in healthcare is in the adoption of health IT and of interoperability, which is increasing, according to Gary Christoph, the first CIO at the Centers for Medicare and Medicaid Services and who now works for a major contractor.
As health IT reaches a tipping point, “consumerization of health care will be de rigueur in a few years,” he said.
For providers, this means that healthcare delivery is undergoing a fundamental transformation, which will certainly occur “as consumers become more demanding of positive outcomes and more familiar with the digital records of their health,” Christoph said.
Meaningful use stage 2 requires just that to happen for providers to receive Medicare and Medicaid incentives under the program shepherded by CMS and the Office of the National Coordinator for Health IT. Some providers say these requirements are too difficult to comply with, while others say that the rules do not go far enough.
Others see the healthcare landscape as putting considerable strain on providers.
Healthcare reform has forced the intersection of two crossing lines – physician adoption of clinical information systems and pressure on the hospitals to receive meaningful use payments, according to Sam Bierstock, MD who no longer practices but is a technology consultant based in Delray Beach, Fla.
“The result is enormous pressure by the hospitals to force the physicians to use EHRs that are not necessarily very user-friendly and therefore disruptive to their work and to their efficiency,” he said, adding that hospital EHRs “are simply not yet adequately intuitive to meet the needs of clinicians.”
With full implementation of ACA, the anticipated introduction of 30-40 million people to the healthcare system will strain an already current shortage of primary care physicians. The surge of new patients will likely mean increasing the load on emergency rooms, which will be the source of care for people who cannot find a primary care doctor, Bierstock said.
“Most EHRs result in a 20-30 percent decrease in efficiency of emergency room doctors and an increase in the people who leave without being seen due to extended wait times. I believe our EDs will be overflowing and less efficient due to the pressure to adopt and utilize EHRs,” he predicted. The same may be true of referral clinics in hospitals for the same reasons.
Providers also face mounting expenses as a result of HITECH regulations, which authorized the EHR incentive program but also strengthened security and privacy requirements, “which are complex, costly to implement and poorly understood by the majority of providers,” Bierstock added.
As part of the new healthcare environment, providers feel under pressure to gather and analyze more data, adhere to guidelines of treatment that are tied to reimbursement, and adopt clinical technologies.
Despite the progressively difficult requirements asked of providers for meaningful use, Christoph said, “Physicians who adopt the requirements will be ahead of the game, and more likely to survive in an increasingly digital climate.”