Assessing the payoff from Meaningful Use of EHRs
The Health Information Technology for Economic and Clinical Health Act of 2009 included $27 billion to help doctors, hospitals, and other healthcare providers buy and install electronic health record (EHR) systems. Through November of 2013, about $5.8 billion of that had been paid to physicians who had successfully attested to the first stage of the Meaningful Use program (MU1).
With the start of 2014, physicians can begin attesting to MU2, the program’s second stage, making this an opportune time to pause and ask what physicians—and the healthcare system generally—have gotten for that money.
As is often the case, the answer depends on whom you ask. For many primary care physicians (PCPs), especially those in solo or small independent practices, the answer would be “very little”—unless you count frustration, lost productivity, and sleepless nights.
Many policy analysts, however, and even some practicing physicians, say that it’s still too soon to know what the payoff from adopting EHRs will be, or in what form it will occur. They point out that in other sectors of the economy, such as manufacturing or banking, it took many years for widespread computerization to begin paying substantial dividends.
One thing that is certain is that the number of doctors using EHRs has increased—from about 17% in 2009 to about 50% through the first half of 2013, according to the U.S. Department of Health and Human Services, which administers the Meaningful Use program through the Centers for Medicare and Medicaid Services.
Doctors vocal in their unhappiness
Practitioners’ unhappiness with EHRs was expressed throughout Medical Economics’ 2-year “EHR best practices study.” Daniel Goodman, MD, a solo internal medicine practitioner near Atlanta, Georgia, spoke for many when he said: “I can’t believe this is what I’ve been going through. I’ve been feeling this depression because I’m spending my time staring at a computer and trying to get it right to achieve meaningful use.” Andrew Garner, MD, a solo family practitioner in Glen Falls, New York, likened the time and effort required for installing his EHR to returning to medical school.
More broadly, a 2013 RAND Corporation study of factors affecting physicians’ professional satisfaction found that although many doctors recognize EHRs’ potential for improving healthcare delivery, the technology reduces professional satisfaction due to factors such as poor usability, time-consuming data entry, interference with face-to-face patient care, lack of interoperability among different systems, and degradation of clinical documentation. “Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, one that our findings suggest has not yet matured,” the report notes.
Ironically, another RAND study, from 2005, was one of the catalysts for the Meaningful Use program. The study estimated that widespread EHR use could reduce overall medical spending by $81 billion annually. But an editorial published in the January 2013 issue of Health Affairs noted that healthcare spending had grown from $2 trillion to about $2.8 trillion in the 8 years between the two studies, and that EHRs have yet to fulfill their promises of greater efficiency and lower costs.
The belief that EHRs could dramatically improve the quality and efficiency of healthcare rests on healthcare policymakers’ faith in the transformative power of collecting and managing large quantities of data, says Jason Mitchell, MD, director of the Center for Health Information Technology for the American Academy of Family Physicians.
“We work from the theory base that many of the key problems occurring with healthcare quality and efficiency are related to data management, Mitchell says. “And managing data in paper charts has been a key problem in why we haven’t been more efficient and able to monitor quality more effectively.” Consequently, the thinking went, doctors only need to digitize their patients’ records for the healthcare system to begin reaping the same rewards.