The final federal rule on meaningful use (MU) of electronic health records (EHR) is being published at the same time this weekly blog gets posted, so log on next Tuesday for my initial commentary on the resulting regulations. However, one compelling reason for adopting EHRs—their potential for producing much-needed and valuable improvements in caregivers’ productivity—will not be addressed in the final rule. I want to make sure that the positive link between electronic records and the output of labor does not get lost in the din of MU discussions unleashed today.
The absence of concern with EHRs’ contributions to productivity is not an oversight of federal regulators or providers who spoke up during the public comment period. Congress was focused on other issues, such as quality of care and security of protected information, when it passed ARRA/HITECH in response to the dismal economic circumstances of early 2009. The recovery law appropriated substantial sums for creating HIT jobs in technical support services, not expanding the supply of clinical care.
The “reform” laws enacted this March include significant appropriations to address the recognized shortage of health professionals, but the supply of caregivers will not be expanded for nearly a decade. In the meantime, provider organizations will not have enough professional personnel to meet existing demand, particularly in the underserved area of primary care. Today’s final rules on MU will define how a “qualifying” provider can use EHR to qualify for incentive payments, but they will not explicitly help today’s caregivers deliver acceptable levels of care to more patients each hour.
Health care executives will spend lots of time over the next few months deciding whether becoming a “meaningful user” is worth the HITECH “carrot.” I suggest that they should conduct a parallel analysis to see how investments in HIT might be used to increase professional productivity, independent of potential MU reimbursement. For many provider organizations, the increase in net revenue associated with EHR-enabled improvements in output per practitioner may actually be greater than the incentive payments—without the costs of reporting and compliance! For example, HIT that allows a nurse or a physician to treat one more patient each hour could generate a better ROI than an investment made solely to comply with “meaningful use.” What do you think about this alternative focus on productivity to justify investments in HIT?
Log on next week for my initial reactions to the final rule on MU. Better yet, publish your comments between now and then in the spirit of generating a healthy discussion.
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