New Rules Raise the Bar (and Questions) for Healthcare IT

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Electronic health records (EHR) are poised to trigger a new era of improvements in today’s healthcare systems, benefiting doctors, hospitals, insurance providers, researchers and, most notably, patients.

TOWN HALL EVENT: Ask your questions about e-health records

It isn’t happening overnight. Replacing the culture and practices that surround medical recordkeeping is a formidable task. For centuries, hand-maintained charts have been used in delivering patient care and communicating among providers.

To aid doctors and hospitals in the transition to EHRs, the U.S. government’s Centers for Medicare & Medicaid Services developed incentives for professionals and hospitals that could meet an initial set of benchmarks demonstrating the “meaningful use” of EHR systems in their practices or institutions.

By 2014, the next set of benchmarks, dubbed “Stage 2,” will introduce a new level of requirements for meeting the “meaningful” standard. Erica Drazen, managing director of CSC’s Global Institute for Emerging Healthcare Practices, says that while the intent is the same — to drive the adoption and use of EHR systems — the focus of the rules, and the potential implications, are markedly different.

“The ‘meaningful use’ standards and rules were developed to help institutions adopt EHR systems in a way that creates value,” Drazen says. “Stage 1 rules focused on capturing data in digital form. Stage 2 will focus on involving the patient and changing care outcomes, and that raises a number of interesting questions for practitioners, institutions and patients.”

Changing old habits

The most significant adjustments may be the changes to workflow in the course of a patient’s treatment. Replacing paper records can cause unexpected consequences, says Dr. Robert Wah, vice president and chief medical officer of CSC’s North American Public Sector (NPS) – Civil and Health Services Group. (See also: Full interview with Dr. Wah)

“In an early EHR implementation, one of our first clinics called and said, ‘We’ve got people stacked up in the waiting room. As soon as we put your system in, we backed up.’ When we looked into this, we found that when the patient checked in, there was no chart to put behind the front desk,” Wah says. “Because of that, the people who watch the front desk for a chart never picked up a patient to take [his or her] vital signs to start a process. The immediate solution was to put a piece of cardboard in the rack to simulate a chart. That’s [an example of] how wed we are to our paper-based systems.”

Stage 2 rules affect another group with old habits that may be equally ingrained: patients. Drazen believes this will be the most challenging aspect of meeting the new meaningful use standards. “Ten percent of patients will need to use an EHR to look up their health information, and at least 10% will need to use the system to send a message to their doctor,” Drazen says. “As a provider, you can only educate and encourage patients to use these capabilities. You can’t compel them.”

Drazen expects more cultural changes to surface as the use of EHR systems grows. For example, EHR incentive rules require the attending physician to record an initial cause of death. This practice is typically handled by a pathology department, and many physicians are uncomfortable with the change.

“We can tell which of these requirements are most difficult because many were optional under Stage 1. Very few participants chose to be measured by requirements that involved coordinating care across settings or patient participation,” Drazen says.

Stage 2 costs

Meeting the new requirements of Stage 2 won’t be cost-free. Drazen believes most healthcare providers will need to move to new systems designed to meet the higher standards. Information system vendors are developing new systems designed to pass certification tests for the 2014 deadline. Additional hardware and storage may also be needed to support the higher datacapture requirements of the new standards.

“This may be the big ‘wow’ in the Stage 2 rules for many institutions,” she says. “We’re recommending that clients find out right now if the system they’re using will be brought to the 2014 standard. If not, that means they’ll need to figure out a new upgrade path.”

Drazen also points out that a range of reporting and coding requirements are changing in Stage 2. New rules call for institutions to assume new tasks. Stage 2 requires that at least 10% of all medication administrations be recorded electronically in the hospital, including a scan of the actual medication. While many medications come in pre-coded dose packs, others do not. “The responsibility to tag these medications will fall to the individual facility,” Drazen says. “Developing that kind of capability may be a big undertaking for small facilities.”

New EHR trends: It’s all for the good

Despite the anticipated costs, workflow changes and the unexpected consequences that may follow, Drazen says that doctors and institutions alike are embracing the move to EHRs and digital systems. Phased implementation is helping to ease the transition.

“We’ve all learned from the past that how you implement these systems makes all the difference,” she says. “No one is complaining that these requirements are unnecessary or won’t contribute to better care. These new rules have been thoughtfully designed by huge numbers of volunteers to help make sure they are focused on real requirements that will change outcomes.

“These aren’t requirements that are unknown to the healthcare industry,” Drazen says. “These are all the things we’ve said we should be doing to promote better healthcare and outcomes for patients. Now we are.”

DALE COYNER is a writer for CSC’s digital marketing team.