WASHINGTON – Electronic health records are only a beginning of sorts. Although a top priority for providers, the meaningful use of EHRs is not the end goal – rather, the health data that EHRs make more accessible stands to unleash a wave of applications, products and services that ultimately catalyze improvements in health care, delivery and outcomes for both individual and population health.
That is ONC’s ambitious vision, which means that National Coordinator Farzad Mostashari, MD, is essentially responsible for leading the charge. He spoke with Government Health IT Senior Editor Mary Mosquera and Editor Tom Sullivan on June 15 at the Government Health IT Conference here about the areas in which he sees innovation blossoming, the contentious nature of EHR usability, how overwhelmed providers should plan for all the incentives and unfunded mandates and why the healthcare industry will keep moving forward even if the White House administration should change next year.
Q: ONC is credited with unfreezing the market for EHRs. What other areas or tools besides EHRs do you expect to see markets grow around to support meaningful use and other healthcare efforts?
A: An innovator said that data is oxygen for us, and there is a lot more oxygen in the environment now. Electronic health records are creating more and more electronic information and we’re creating more and more liquidity with that information, and the innovation potential is even greater in all of the different applications that can come around those EHR transactional systems than even in the EHR space itself.
So what I expect to see innovation in are things that help organizations, accountable care organizations or practices for the first time the healthcare providers to purchase services that can help them do population health management, help them identify patients at high risk, predictive analytics, reaching out to a patient and effectively communicating with the patient and helping bringing those lost to follow-up back into care, helping induce and support behavior change, those are where I see tools to help monitor and enforce medication adherence, those are the things that I see the most potential for innovation. Not the clinical system per se, in terms of transactional clinical system, but all the things you can do once the information is in electronic format and once you have the motivation to do population health management.
Q: Are you seeing anything from the Health Data Initiative Forum, and all the applications they presented, that can be connected with meaningful use?
A: I think a lot of those will ride on top of the capabilities that are enabled through meaningful use. If you want to have an application that will help people to stop smoking, to have the systematic collection of smoking status in the EHR feeds that. If you have quality measurement for blood pressure control, and you want to improve blood pressure control, then you’re going to have applications that build on top of the EHR, whether it’s medication adherence or dietary counseling or weight loss control.
Q: Some vendors promise an EHR that meets all the criteria of Stage 1 but is still not really usable. What is ONC doing to foster some sort of usability?
A: We hear this all the time and we’ve had a couple of public hearings on usability by the Health IT Policy Committee. It was fantastic getting all the perspectives. For providers, this is a top priority for them, not just that you have a system, but systems that make it pleasurable, make it efficient and make it safe to take care of patients. My predecessor Dr. David Blumenthal used to say that his dream was for providers to be excited to boot up their EHR when they come to work the way that you enjoy, say, lighting up your iPad. It’s not true that doctors are late adopters of technology. I saw some incredible statistics around iPad and smartphone adoption by physicians. It’s clear that the provider community and from the research that improving the usability of systems is an important goal. The question is how do we do it?
But you can’t fix something that you can’t see. So we have to have some common sense measures and metrics for how we’re going to agree what are the most important dimensions of usability that can be reliably measured. I think that’s the first step, to get together folks in an open process that includes providers, academics, vendors, and [determine] what makes sense in terms of usability. Two, bring transparency to the decision making process. There are lots of ways once you have the measures that that can be implemented, anything from voluntary testing to challenges. If you have a usability framework, maybe you can have a challenge that will highlight the award winners for usability. That will drive the market to value and compete on the measures of usability. The option for regulatory action is, I suppose, there. But it’s premature to talk about. First, we have to make sure that we have measures, and second bring transparency, and then we’ll go from there.
Q: ONC’s Doug Fridsma said in a session at the conference that the main way of exchanging health records, even electronic ones, is still print-fax-scan. So how can ONC lead the industry over that hump to electronic exchange?
A: I think what we want to do in the first place is to improve over print-fax-scan. The ability of EHRs to be able to export summaries of care records in structured format, the ability to send that securely over the Internet using Direct protocols and the ability to incorporate that, either as human readable or in the future computer readable, those are going to be key building blocks that we’re going to make measurable progress toward this year.