“A successful man is one who can lay a firm foundation with the bricks others have thrown at him.”   ~David Brinkley

With the goal for every American to have an Electronic Health Record (EHR) by the year 2014, the Federal government is throwing many ‘bricks’ at physicians. It will be interesting to see if these bricks will actually build a foundation for EHR success; or, act as roadblocks on the way to widespread ‘meaningful use’ of EHR technology.

Metaphorically, I will relate the ‘bricks’ in Mr. Brinkley’s quote to the policy and programs tied to the billions of dollars in ARRA funds allocated for Health IT. Under the HITECT Act, language suggests that physicians are eligible for about $44,000 in incentive payments through Medicare or Medicaid if they prove ‘meaningful use’ of an EHR. Months after the passing of the HITECH Act, the definition, conditions, and standards of ‘meaningful use’ are still under debate.

Such debates have continued for several reasons, but mainly for concerns about:

  1. What outcome measures physicians must meet and report to prove ‘meaningful use’ of an EHR;
  2. Certification standards and certifying bodies for EHR products;
  3. ‘Meaningful use’ and certification standards not meeting physicians’ practice needs;
  4. Security and privacy of health information; and
  5. Interoperability/sharing of health information.

To address the first issue, ‘meaningful use,’ CMS, the Office of the National Coordinator for Health IT, and the HIT Policy and Standards Committees are still in the process of developing regulations to govern the initial year of the incentives programs, including a definition of meaningful use for 2011. The drafted recommendations for ‘meaningful use’ from the HIT Policy Committee were quite daunting, and subject to much criticism. As the final standards for meaningful use are anticipated for announcement, many are still questioning how to set attainable outcome measures worthy of Federal incentive payments. As stated in the policy, if a physician accepts Federal payments, but is not able to meet and report the outcome measures by 2013 and 2015, s/he may be subject to financial penalties. The bar is set high for EHR adoption; trying is no longer good enough, results- as per the Federal standards- must be shown. However, if these government standards are unattainable, the incentive payments, or ‘bricks,’ will be merely roadblocks.

Certification standards for EHR technology are also under scrutiny. Currently, the main certifying body is the Certification Commission for Health Information Technology (CCHIT), but this may soon change. The government has mentioned the potential development of an HHS certification. CCHIT has altered its criteria to develop both Comprehensive and Preliminary ARRA Certification programs, trying to predict the standards for meaningful use and measure EHR products against them. Unfortunately, even a CCHIT certified product can’t-at this point- guarantee that if a physician purchases x EHR, s/he will qualify and obtain incentive payments. It will be interesting to see how much the ‘certified’ EHRs return ‘successful’ EHR implementations and incentive payments.

Some EHR companies are staying far from the certified market, and developing their own innovative products. Hybrid EHRs have evolved to address concerns that the current certification standards are not considering what physicians need an EHR to do for their practices. Hybrid EHRs tend to focus on business aspects of a medical practice, and help a practice implement a product that will increase efficiency, productivity, and profitability, which will in turn result in improved patient care. Many argue that the physician’s voice is lost in the ‘meaningful use’ debate, and hybrid EHRs prioritize listening to this voice.

The last points of this article will address concerns over interoperability and privacy of health information. As goals to exchange health data to other entities increase, the privacy concerns also rise. As more information is shared, the potential for security breaches increases exponentially. It is hoped that the infrastructure for widespread adoption of EHRs will meet the security and interoperability standards for ‘meaningful use;’ however, this is treacherous and uncharted territory. Many are highly concerned that the ‘figure it out as we go along’ motto could result in many dangerous health information security breaches.

Will it be hard for the average physician to be successful with the bricks he is thrown to adopt an EHR? Yes. Is it impossible? No. The determinations for ‘meaningful use’ are expected in the coming weeks, and it will be interesting to see how these terms are perceived and how this will influence the incentive program’s implementation. Physicians have a lot at stake -their practice, dignity, patients, livelihood, etc.- and they must evaluate their individual motives and goals for adopting an EHR, and select an EHR that meets such goals. If practice goals align with those of the ‘meaningful use’ standards, perhaps the Federal resources will be of tremendous benefit. If practice goals do not align with the Federal government, accepting those resources may turn out as roadblocks to EHR success.