Meaningful care, not just meaningful use

We should be discussing health IT's life altering—or saving—potential
By William Bria, MD
08:26 AM
Holding hands

Enough talk about information technology's use in the practice of medicine.

Health IT must become the practice of medicine.

Industry rhetoric revolves around deadlines, delays and debates about health IT's benefits, largely because of the federal government's Meaningful Use requirements for EHRs.  But we should be discussing health IT's life altering—or saving—potential to provide Meaningful Care instead of deliberating Meaningful Use, which has become stigmatized as an intrusive mandate focused on funding rather than care.

From documenting how exercise may help lower blood pressure by analyzing EHRs to coordinating care through open technologies, providers, researchers and payers are already leveraging health data to improve patient care. We must next demonstrate and leverage the value of Meaningful Use if we are to use health IT to provide Meaningful Care.

Communication and connectivity will be vital in moving from Meaningful Use to Meaningful Care, and in creating a learning health system that equips physicians and their patients with comprehensive medical histories and best practices for enhancing wellness.

We must broadly research the effectiveness of health IT and build awareness of the ability to use data to improve care if we are to shift from discourse on Meaningful Use to discussion about Meaningful Care.

We need more studies that demonstrate that health IT represents a safer, better, more useful approach to practicing patient care.

Though 85 percent of physicians have adopted EHRs, only 24 percent say they have improved their efficiency while 46 percent claim that they have impaired efficiency, according to The Physicians Foundation's 2014 Survey of America's Physicians.

Some physicians resist implementing or using EHRs because they do not view them as a self-evident necessity to adopt, as they would CT imaging technology for example. Unlike other technologies, EHRs have evolved through an incredibly complex, and often unpleasant, process of trial, error and failure that has been marred by disputes over whether their usage contributes to better care.

But the benefits of leveraging data have since been documented in literature for almost every specialty, including surgery, obstetrics and pediatrics. The application of  informatics has resulted in improved patient outcomes such as decreased infection rates and quicker discharges from hospitals.

Automating workflows based on proven best practices and advanced knowledge gleaned through the analysis of data sets also ensures that patients receive appropriate care in rapidly evolving specialties and subspecialties in the practice of medicine. We can further refine treatment protocols and improve as we collect and analyze more information.

Only a robust information environment will allow us to make such widespread improvements, and better communicating the benefits that have been reaped so far will demonstrate health IT's greater potential.

We are not where we need to be in terms of interoperability. The lack of standardization and cooperation among competing health IT vendors has stymied the ability to coordinate care.

Though increasingly common, EHRs do not necessarily result in coordinated care, according to a study of the role of health information technology in coordinated care, published in Medical Care. “Although a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT, more than one third did not routinely receive the needed patient information at all,” researchers concluded.

The Office of the National Coordinator for Health IT recently released the first draft of an Interoperability Roadmap for public comment. “Health IT that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is essential to better care, smarter spending and a healthier nation,” the ONC states on its interoperability webpage.

Unfortunately, some healthcare systems are stuck with EHRs implemented by now defunct companies, which withered in a market that grew up fast. Technologies that shouldn't have been adopted sometimes were, leaving their purchasers with sunk costs and sour tastes for the next breed of EHRs.

The latest technologies must be accessible even for smaller healthcare systems if we are to create an an interoperable health IT ecosystem that we can leverage to improve patient care.

Patients must also be able to access and share their information. Initiatives like OpenNotes are promising in this regard, but we must accelerate the adoption of such technology if we want to better coordinate care.

Achieving total interoperability is essential to securing an integrated information environment that facilitates the delivery of improved patient care based on data.

Though we have come far in achieving Meaningful Use, much progress must be made towards that end and still more work must be done if we are to use health IT to provide Meaningful Care. We must demonstrate and communicate the benefits of having a national network of information that provides insight into the health of the patients we serve if we are to improve the care that they receive.