A Multi-Stakeholder Discussion in Washington

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Posted By: Industry Expert June 1, 2016

John HalamkaBy John Halamka, MD
Twitter: @jhalamka

On Thursday, May 19th, I spent the day in Washington with a group of government, provider, and developer stakeholders convened by the Institute for Healthcare Improvement. We operated under Chatham House Rules, so I can summarize the discussion but not identify any of the participants or their specific statements. Below are three questions we discussed and the observations we made:

1.  What worked in CMS and ONC rules (HIT related regulations)?

  • Meaningful Use provided a foundation of basic electronic record functionality
  • We enhanced systemness thinking and created learning groups to address vulnerabilities in disconnected systems
  • We made safety improvements and enabled analytics
  • We enhanced patient engagement and dispelled several myths
  • We automated quality measurement processes and recorded social determinants of healthcare
  • We encouraged EHR optimization
  • We enhanced Interoperability for public health transactions, eprescribing and entry of vocabulary controlled data (problems/meds/allergies/labs)
  • We incentivized new entrants into the marketplace
  • We enabled standardization of workflows
  • We found that CMS was a good listener
  • We began to engage post acute providers
  • We caused infrastructure to be upgraded (to support EHR implementation)
  • We enabled remote access to records
  • We created an ecosystem for home care devices and wearables to become relevant
  • We taught stakeholders that clinical automation is not an IT project
  • We began to focus on the user experience

2.  What didn’t work or could have been done better?

  • Products were rushed to market and they were not as usable or as intuitive as we’d like
  • We did not achieve a consensus on national priorities – where we want electronic records to be in 5 years
  • We did not include behaviorial health providers
  • We did not enable team communication
  • We did not enable substitutable apps that can be shared across vendors
  • We required too much non-valued data entry
  • We often digitized the paper world
  • We ended up with regulatory complexity
  • We required too many clicks, causing a loss of patient focus
  • Once the foundation was laid we did not have time to digest the changes, interatively improve and innovate
  • Certification consumed too many development resources
  • We hired scribes as a workaround to overwhelming data entry requirements
  • We required documentation to satisfy legal and regulatory concerns rather than patient care needs
  • We demanded Interoperability without first building enabling infrastructure
  • IT service levels did not always align with clinical requirements
  • We underestimated the burden of the impact of HITECH on providers and developers
  • We made patient engagement too hard
  • We did not turn data into information, knowledge and wisdom
  • We focused on compliance instead of joy in the workplace (or joy for the patients)
  • We did not enable the marketplace to meet customer demands
  • We focused on billing rather than clinical workflow
  • We tried to do too much, too soon

3.  How do we shape the future based on lessons learned?

  • IHI Leadership Alliance/EHR workgroup should submit a comment letter about MACRA/MIPS to CMS
  • Reconciling the tension among Developers, Government , Providers, Patients will required agreement about who is the user/customer, what is success, what is considered a good outcome
  • Instead of just Interoperability we need to think about the functionality needed for a collaborative work and a more uniform user experience
  • We need to build Infrastructure enablers – a catalog of constrained standards, a national patient identifer (or private sector solution i.e. CHIMEchallenge/Commonwell/Surescripts/CareEverywhere), a national provider directory, a trust fabric, uniform consent policies among states
  • We need to align economic incentives among stakeholders
  • We need to consider the impact of the emerging consumer driven digital ecosystem
  • We need to recognize that the EHR is not the center of the universe and enable other tools such as EHR agnostic warehouse solutions
  • We need liquidity of claims data
  • Documentation/coding rules need to enable team-based care by all clinicians
  • We need education to dispel fear of HIPAA and enable a culture of sharing

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Member of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.