Is the post-EHR era upon us?

Now that everyone is using electronic health records, let's start talking about what comes next
By Mike Miliard
02:45 PM
Doctor touchscreen

When announcing his company's seismic $1.3 billion acquisition of Siemens Health Services this past summer, Cerner CEO Neal Patterson noted the deal was meant, in part, to help the electronic health record giant chart a course for the "post-meaningful use" era.

Buddying up with a company as broadly skilled as Siemens was meant to be a strategic pivot toward "the next decade," said Patterson. "The alliance we're creating will drive the next generation of innovations that embed information from the EMR inside advanced diagnostic and therapeutic technologies."

Well, perhaps "post-meaningful use" isn't quite the mot juste.

As Mark Segal, chair of the HIMSS Electronic Health Record Association, reminds us: "Meaningful use is forever."

Sure, it eventually switches from incentives to penalties. But unless and until the law is changed, "it doesn't sunset. That doesn't mean it can't, but it's not written to," says Segal.

Or then again: Perhaps it may be over sooner than anyone thought?

Upon hearing of the Centers for Medicare & Medicaid Services' August Stage 2 rule change – ostensibly meant to offer more flexibility, but also requiring 365 days of EHR reporting in 2015 – CHIME CEO Russell Branzell struck an apocalyptic tone.

"CHIME is deeply disappointed," he said, echoing frustration held by many other stakeholders on the provider and technology vendor sides. "Now the very future of meaningful use is in question."

Upon learning of the rules newly-onerous requirement, one commenter on was more willing to put it definitively: "Lets all take a deep breath, and say it: Meaningful use is dead. Now is the time to figure out what to do next."

Whether or not there's any such thing as a "post-meaningful use" era, there's been plenty of discussion recently of a "post-EHR era" – one in which, with the basic commodity of electronic health records now in place and in use, the technology can evolve and improve: better usability and design, mobile device interfaces, more seamless interoperability. 

The EHRs of the future will be more intuitively designed to support new models of care delivery and payment, observers say. They'll be souped up with analytics capabilities, able to digest consumer-generated data from Fitbits and Jawbones, robust enough to handle a flood of genomics data and translate that into finely personalized clinical decision support.

One day – sooner, or later – the attestation deadlines for meaningful use will be but a memory. But EHRs will still be in place, and, hopefully, much-evolved from their current form, helping deliver care in new, innovative and more effective ways.

Install base

This summer, the U.S. Department of Health and Human Services touted new data from the Office of the National Coordinator for Health IT that found "significant increases in the use of electronic health records."

A pair of studies, published in Health Affairs, showed how, by 2013, some 78 percent of office-based physicians had adopted some type of EHR system – and about 48 percent were using EHRs with advanced functionalities. Meanwhile, 59 percent of hospitals had "adopted an EHR system with certain advanced functionalities in 2013, quadruple the percentage for 2010."

So there you have it: By those metrics, Stage 1 meaningful use has been a smashing success. EHRs have been adopted, implemented and are now widely in use, all in just the past five years. Moreover, more and more providers are using systems designed for more than just basic record keeping.

"Patients are seeing the benefits of health IT as a result of the significant strides that have been made in the adoption and meaningful use of electronic health records," said National Coordinator Karen DeSalvo, MD, in a press statement celebrating the results.

Still, she acknowledged, there was plenty of work yet to be done, most notably on interoperability. Stage 1 may have been a relative cakewalk, but Stage 2, as we've seen, has so far been anything but.

"We look forward to working with our partners to ensure that people's digital health information follows them across the care continuum so it will be there when it matters most," said DeSalvo.

As John Halamka, MD, chief information officer of Boston's Beth Israel Deaconess Medical Center was quoted across the Twittersphere after a briefing on those adoption numbers: "EHRs are bi-planes, not yet jet aircraft."

Indeed, John Glaser, CEO of Siemens Health Services – and, back when he was CIO of Partners HealthCare, Halamka's cross-town counterpart – echoed those sentiments in an August interview with Healthcare IT News.

Asked for his thoughts on the "post-EHR era," Glaser said, "I'd be a little careful with the 'post' word. Because there are a lot of EHRs in place that are not used as well as they should be. The technology has been installed, but the organization hasn't leveraged it as well as they should to reengineer their processes and improve care."

While there's a point "at which you shift from installing the technology to really making it work, and work well," he said, too many providers are still not there yet. "So, better to say 'post-installation,' for lack of a better word."

Despite the encouraging uptake numbers, DeSalvo too seems to recognize that most back-patting should be delayed until EHRs are a universal currency. "The policy goal is for everybody to come along and for us to not leave anybody behind, and that includes those served by rural and critical access hospitals," she told Politico

Nonetheless, it's hard to argue that for the majority of providers, inpatient and outpatient, EHRs are here to stay: widely-used, and almost taken for granted.

A tossed-off turn of phrase in the recent HIMSS Analytics Ambulatory Practice Management and Electronic Health Record study seems to bring that point home: Once so exotic, perhaps even frightening, to physicians, EHRs are now seen as "standard business tools," according to the report.

So now what?

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