Evolving Beyond Meaningful Use and into Intelligent Communications for Value Realization – It’s About Time

It’s hard to believe that it’s been close to a decade since the phrase “meaningful use” entered the healthcare lexicon, spurred an unprecedented wave of health IT adoption, and revolutionized the way provider organizations interact with electronic data.

In 2011, when the Centers for Medicare and Medicaid Services (CMS) introduced the EHR Incentive Programs, less than a third of hospitals and physician offices had a basic electronic health record in place – and few organizations were truly able to use their digital data meaningfully.

The EHR Incentive Programs aimed to change that by defining criteria for certified EHR technology (CEHRT) and offering financial incentives for adopting and leveraging the tools in specific ways. The three-stage program was designed to guide participants through the process of achieving digital maturity, starting with capturing data and progressing to sharing data, refining clinical processes, and ultimately improving outcomes.

Unfortunately, when we step back and objectively look at where we are now, we see that meaningful use and its $32 billion in incentive payments have left us with a mixed legacy, including widespread data fragmentation, poor user experiences, overworked providers, and financial waste.

To get back on track and achieve the ultimate goals of meaningful use and the Triple Aim (better outcomes, lower costs, and improved patient and provider experiences), healthcare organizations will need to take new, relevant, and more precise data-driven approaches to the age-old challenge of realizing value across the care continuum.

The checkered history of meaningful use

While meaningful use was highly effective in encouraging EHR implementations, participants might have met the letter of regulations but struggled to meet the intended objectives of the program, leading to numerous changes and delays.

A focus on process measures instead of outcomes led to accusations of “check box” medicine and consumed countless hours that may have been better spent on direct patient care. Providers found it particularly challenging to meet the criteria for health information exchange, data interoperability, and patient access to information. And even when data was available, its multiple different taxonomies and local interpretations made it rarely used for informed, intelligent decision-making.

In 2015, when most hospitals were in the midst of Stage 2 meaningful use, only 46 percent reported having access to necessary patient information from providers or other sources outside their network, according to the Office of the National Coordinator for Health IT (ONC).

Even more concerning, 36 percent of hospitals said they rarely or never used the information anyway. The vast majority of these organizations complained the data was not integrated into the EHR workflow, wasn’t always available when needed, and wasn’t presented in a useful format.  So, how could we blame them for not using the information that was not helpful?

Meanwhile, technology outside of the healthcare ecosystem was advancing at lightning speed, creating a jarring disconnect between the convenience and value of what we use in our daily lives versus what is used for medical care.

In our day-to-day technology usage, application programming interfaces (APIs) and other strategies started to enable an entirely new generation of tools to locate, aggregate, and present disparate datasets in smart, intuitive ways. Artificial intelligence exploded onto the scene, offering the potential for powerful personal assistants, incredible scientific discoveries, and breakthroughs in optimizing workflows.

As a result of these external innovations, consumer expectations started to change as well. Patients and providers have continually expressed deep frustration at healthcare’s inability to keep pace with the rest of the digital world and leverage information in a purposeful, efficient way to reduce wasted time, effort, and money.

While the EHR Incentive Programs were rebranded as “Promoting Interoperability” in 2018 to refocus on ubiquitous data liquidity and encourage the transition to data-driven value-based care, it has not yet managed to jolt the industry into a new state of being. Healthcare remains siloed, riddled with wasteful spending, and subject to criticism over lackluster patient and provider experiences.

Taking the next steps beyond the Incentive Programs

With the impact of the pandemic and continued advancements in technology, healthcare is now at its tipping point. The industry must make the choice to include – but also evolve past –  the EHR as defined by the certification criteria of meaningful use and develop a health IT infrastructure that brings true value to patients, providers, and the health system as a whole.

Organizations can begin this process by understanding where their current information systems succeed in supporting an efficient, intelligent patient care ecosystem – and where their technology needs extra enhancement to achieve these ultimate goals.

For many providers, data interoperability and integration into the workflow remains a major pain point. As we’ve discussed previously, positive EHR usability experiences are still hard to come by and fewer than 70 percent of organizations feel they have sufficient access to necessary information at the point of care.

The resulting waste from low-value care and insufficient care coordination consumes about a third of our national healthcare budget. That’s more than $400 billion a year we can reclaim by catapulting EHRs into the modern era.

Fortunately, a lot has actually changed since we started meaningful use. Slowly but surely, organizations have been building the connections and aligning the incentives required to make interoperability a reality. And EHRs are becoming more standardized and open than ever, creating the right environment for innovative technologies to elevate existing health IT infrastructure into a precise and actionable tool for better patient care.

But the data remains siloed, fragmented and difficult to use for its intended purpose. Further success will depend on what technologies we choose to connect the data siloes and create effortless, comprehensive, data-driven workflows achieving defined and specific evidence-based outcomes.

Achieving value with the next generation of intelligent technologies

To move past the legacy era of multiple disconnected systems, healthcare organizations must address the perennial issue of access to curated, relevant, actionable data directly within the clinical workflow.

Clinical and executive leaders can no longer expect end-users to perform the intensive cognitive labor of finding where data lives, extracting it manually, trying to figure out what it means, and synthesizing the data into something meaningful for decision-making and appropriate action – all while meeting with a patient for a scant 15 minutes, at best.

Instead, organizations will need to augment their systems with advanced, context-sensitive automated tools to perform these functions in the background and simply present the right information to the user in a contextualized manner without forcing any deviation from the workflow.

This type of technology did not exist at the beginning of the EHR Incentive Programs, when EHR developers were creating the foundations of the digital healthcare ecosystem. The current health IT situation might look very different if it had.

But now, as we move into 2021, we have the opportunity to take what we have and build upon it to usher in a new era of precise and intelligent data utilization.

It is time to apply 21st century technology to 21st century problems to achieve 21st century outcomes.

When we do, providers can maximize the value of the digital data we have generated for the last decade. And that’s how our health system will generate the value it has long promised to patients, providers, and payers.

If we can achieve these goals at scale, the industry will be able to stop focusing on the challenges of history and start looking forward to delivering the best care for our patients, without burning out our precious care providers, while still eliminating waste and spending our resources where we should. This is what a meaningfully data-driven healthcare system should do. It is up to us now to make this new and better world come to life. It’s about time. Let’s get to work.

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