During an #HITsm tweet chat in February, I asked participants if they believed the momentum in EHR adoption by healthcare facilities initiated from HITECH and Meaningful Use would continue, if for whatever reason, funding for Meaningful Use was halted or stopped completely. The responses varied from tremendously optimistic to mild hesitation and skepticism.
After some reflection on the topic, my perspective on Meaningful Use has changed a bit. Initially, my reaction was, “Of course, EHR adoption would halt. These hospitals need Meaningful Use to encourage the transition.” With little reasoning, I believed Meaningful Use was the sole motivational factor for hospitals to “go electronic.”
After some reflection on the responses from that tweet chat and reading a number of articles on the subject, I have changed my outlook to the increasingly optimistic side. I still believe that for a large number of organizations, economic pressure to adopt the new technology will influence the decision to remain competitive. This pressure will only increase in time, due to Meaningful Use or not.
Users of Quora provided a few additional insights on this question:
I think each hospital’s pace of implementation would slow down, the timetables would stretch out, and the scope of the plan at each center would be dialed back. But too much has been invested (in terms of money, time, effort) already to walk away from it all.
From what I have heard from several hospital CIOs is that much of the work required for Stage 1 Meaningful Use was already underway prior to HITECH passing. What has happened is some of the projects have been re-ordered to align with the incentive plans.
Having said that, hospitals have larger IT staffs to manage a more complex application and infrastructure environment. Although IT resources may be lean, they still have resources to implement an EHR. In clinics, IT resources are usually scarce. Given this, much of the current EHR adoption happening in physician practices would disappear if the Meaningful Use incentives disappeared. Prior to HITECH, EHR adoption in physician practices was happening at a slow pace.
In either case, the use of EHRs would not stop if Meaningful Use stopped. There are operational benefits to using an EHR and, more importantly, patient care benefits which exceed any other ones. Keeping the patient at the center of all EHR and other application efforts will ensure value is obtained, with or without government assistance.
The short answer…YES. The long Answer YES. MU will encourage the adoption of crappy software. Haste makes waste. Cloud computing is coming and with that AI for diagnostic and treatment algorithms.
I don’t think the rapid changes we see in HIT would have happened without MU/HITech incentives, and progress would be significantly hindered if they were to stop.
While there’s significant economic pressure to adopt now, it’s not like the technology involved is anything new. The question is- why are we now beginning to adopt electronic health records when DBMS’s capable of storing medical records have been around for 40+ years? Why didn’t the healthcare industry computerize records when the banking and financial industries did?
I think the answer is that the latter industries had the financial capital to invest, and saw the long term advantages of early adoption. Healthcare providers don’t typically have access to that sort of dynamic capital, so they weren’t in a position to implement EHR before there was federal funding made available to spur them to act.
Now that the ONC has spurred the healthcare industry into action, I don’t think there’s anything that can stand in the way of the inevitable industry wide adoption. Patients are going to expect to have access to electronic copies of their records, and physicians are going to see the value that EHR has in terms of increased productivity, patient safety, research applications, and more. There’s no stopping EHR!
It’s guaranteed that without Meaningful Use demands in place, EMR adoption would be dramatically impacted. The thing is, are we talking about a) no MU and no incentives, b) removing the need to prove MU but still providing incentives, c) substituting some other scheme for improving quality for the current complex, painful scheme? Obviously, if providers got incentives but faced few requirements, adoption would increase. Otherwise, it’s a crapshoot.
Implementation schedules would most certainly slow universally, and would be particularly strong among older doctors and smaller and rural clinics where people aren’t as comfortable with computers.
However, I believe overall success rate would increase. With all of the pressure to get meaningful use within the timeframe, there will be a huge number of failed installations – the doctors requesting less training to save money, and the vendors offering less training time with overflowing training schedules. Across a longer installation and deployment timeline, more time can be allotted to ensure proper training and deployment.
In light of these perspectives, I’d like to ask the question to you as well:
Would growth in EHR use continue if the funding for Meaningful Use was stopped?