The regulations included a mandate for interoperability and items called 'meaningful use'.. The term 'meaningful use' is a misnomer. Meaningful use in their terms only had to do with it's utility in garnering information from an EMR which may or may not be useful for it's designed purpose.
The following statement from Ophthalmology Management specifies some items:
"Switching electronic medical records (EMR) systems is a big decision, even if you feel like throwing your existing system against a wall. So don't ditch your EMR system before you download the paper that includes an eight-question assessment to help you decide - and to protect you from making the same mistake twice. (this statement is from Ophthalmology Management and is a quote from EMA, a specialty EHR for ophthalmology.)"
In many specialties there are fields and specific information unique to that specialty. Clinical work flow must be considered, since a poorly designed software can radically alter efficiency and disrupt the clinic volume and income. Numerous studies have revealed that efficiency can be reduced for several months by a factor of 20-30%.
Medical practices chose to accept incentive payments for consenting to meet meaningful use criteria with their EHR. This occured by an angst of 'not being left behind' despite serious reservations and advice for HHS and ONCHIT. Several deadlines have been delayed and doubts remain about the implementation of MU Stage III.
Many medical practices have invested in EHRs. Some installations were obsolete at the time of purchase.
Some medical practices decide to purchase a new system despite the added costs, preferring to write off an older system with accelerated depreciation. These decisions are supported by a record of decreased patient volume. Most physicians report an additional hour of work each day and a reduction in patient volume.
Many physicians have expressed their extreme unhappiness with their electronic health records. Management surveys continuously confirm dissatisfaction. Despite this, EHR use has grown. Imagine using a defective hammer to drive in a nail. Regulators have taken their eyes "off the ball" ignoring patient care, and equating paperwork with 'quality of care'. This has become a fundamental failure of the entire American health care system. Poor patient care can easily be disguised if all the information which is entered is designed to thwart the 'required entries' to proceed, or satisfy an algorithm for a complete medical record.
There are several certifying standards, the most onerous are those mandated by CMS and regulated by
Adding to this frustration is that many large organizations will select a vendor whose reputation has been built upon usability for primary care and/or internal medicine/pediatrics. Population Health has become a new 'buzzword" in the HIT workspace. A large or medium sized multispecialty group may select a system which their specialists can not use. Interoperability has become a deserved design requirement.
When designing or selecting an EHR, every department must have input on decision making. Some IPAs and loosely organized primary care groups have offered to 'give' an EHR to their specialists t
o encourage acceptance of a group EMR. This in many instances has been disastrous.
Their are other choices.
1. Utilize a specialty specific EHR based upon:
Demonstrated user functionality and efficiency in actual operations.
2. The requirement for interoperability are clearly defined by ONCHIT which should make disparate systems interoperable.
3. The realities however are quite different from a vendor point of view, leaving users holding the proverbial 'bag'.