This is what passes for good news in the EHR world.
That doesn't seem like quite enough, does it? After all, EHR adoption has skyrocketed since HITECH spurred the launch of the CMS incentive program -- and over 408,000 health care professionals have received some $26b in such incentives over the past three years. "Not making things worse!" is a pretty low bar for success.
There's more not-so-good news. A recent JAMA study, by Samal et. alia, looked at the impact of EHR meaningful use on quality of care, and found very mixed results -- marginally better quality results on 2 measures, worse on another 2 measures, and no impact on the remaining 3 measures. The study raised questions about how "meaningful" meaningful use is, and how we best evaluate its impact and the impact of EHRs generally.
Another new report, by D'Amore and colleagues, in The Journal of Medical Informatics, found major problems with even MU Stage-2 certified EHRs being able to exchange and read so-called C-CDA (consolidated clinical document architecture), as required in Stage 2. The study participants were pleased to find that they were able to identify common problems and offer specific solutions, but noted that "without timely policy to move these elements forward, semantically robust document exchange will not happen anytime soon."
That doesn't sound good.
On the other hand, in a piece in Healthcare IT News, Jack Beaudoin says that the debate about EHR effectiveness should be over. He dismisses the Samal study for several technical reasons, and cites preliminary results from a study conducted by HIMSS Analytics and Healthgrades, covering all U.S. hospitals and with a more sophisticated measure of the level of EHR adoption in each hospital.
I've not been able to find any published version of the study, just a tweet from HIMSS, but Beaudoin reports that the study found that EHRs do have measurable, positive impact on the outcomes of care, as measured by mortality. Both he and the tweet cite a heart attack mortality rate half as high for hospitals with high adoption rates compared to those with low EHR adoption rates.
Although not every patient cohort, service line, or diagnoses/procedures had positive results, "overall, all five service lines studied show statistically significant positive relationships to EMRAM scores for at least one group of diagnoses and procedures." (EMRAM is their adoption model.)
I would like to believe Mr. Beaudoin is right, but I think the jury remains out. For example, in a recent report, Rand was rather reserved about the impact of EHRs, citing mixed or modest results on clinical quality. They specifically pointed out the issues of usability and lack of interoperability as major problems, noting that "HITECH promotes adoption of existing systems, not better ones," which I think hits the nail on the head.
Rand specifically called out market leader Epic for how its closed architecture makes interoperability a challenge. They're far from alone in this criticism. KLAS recently focused on Epic's ability (or reluctance) to share data. I would summarize both reports as finding that Epic is fine with connecting with other Epic installations -- of which there are no shortage -- but, otherwise, good luck connecting with them.
A good illustration of this may be that, as I reported previously, Epic recently announced an interoperability consortium (Carequality), which pointedly does not include major competitors like Cerner, McKesson, or athenahealth, who have their own consortium, CommonWell Health Alliance. It'd be funny if it wasn't so important.
As FierceEMR asked in their editorial on the D'Amore study, when it comes to interoperability, do we "fix the potholes, or find a new path?"
Congress may be reaching even its limits for incompetence with the Hatfield-McCoy feuds going on between EHR vendors. Members of both parties are calling for an investigation into what they deem the "information blocking problem." The Senate Appropriations Committee has asked ONC to report how many organizations are involved in the practice, and warned that "ONC should use its authority to certify only those products that…do not block health information exchange."
Rep. Phil Gingrey (R-GA) went a big step further at a House Energy & Commerce Committee subcommittee hearing, charging that:
We’ve spent tens of billions on non-interoperable products. It may be time for us to look closer at the activities of vendors in the space, given the possibility that fraud is being perpetrated on the American people.”