NEW ORLEANS -- Implementing an electronic health record system and meeting meaningful use objectives can be a major challenge for most organizations. At HIMSS 2013, speakers highlighted some of the more common problems users encounter when participating in the incentive program.
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Will Underwood, a senior associate at the Philadelphia-based American College of Physicians, and Alan Brookstone, M.D., chairman and co-founder of Vancouver, British Columbia-based Cientis Technologies Inc., presented survey data collected by AmericanEHR Partners, which showed that physician satisfaction with available technology and the meaningful use requirements is diminishing. The survey received responses from 4,279 physicians.
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According to Underwood, the results showed that doctors increasingly complain about the negative effect of EHRs on workflow, feel they are less productive than two years ago, and are more dissatisfied than ever with the features of their EHR systems. Most of the respondents to the survey had been using their EHR system for over a year, so Underwood said it is unlikely that the results are attributable to new users adjusting to the change.
The meaningful use program is the main force behind the increasing rates of provider adoption. Given its central position, it will be important for regulators to be mindful of EHR-related challenges faced by physicians when crafting new program guidelines.
"I think this is important to think about as we move forward with policy," Underwood said. "Right now we are in a fee-for-service system and we are in a period where we expect a significant influx of patients through the Affordable Care Act and aging population, so we really need to find ways to improve the physicians' workload."
We are in a period where we expect a significant influx of patients … so we really need to find ways to improve the physicians' workload.
senior associate, American College of Physicians
The challenges don't stop there. Brookstone said the results showed that doctors today are less likely to say they see EHRs improving care quality than they were two years ago. They are also less satisfied with the customer support they receive from their EHR vendor. He said that a lot of this is attributable to the continually revolving set of meaningful use objectives. It can be difficult to keep up for some doctors.
"Speed of change is an issue," he said. "There's been a lot that has been thrown at physicians in the last two years and it might just be too much too fast. What is clear to us is providers are struggling with workload and productivity."
The meaningful use program may also introduce security and privacy complications into a practice. The objectives of the program do include a number of data security provisions that are intended to step up safeguards on electronic protected health information as more physicians adopt EHRs. But these rules are not always aligned with HIPAA requirements, said Adam Greene, partner at Washington, D.C.-based Davis Wright Tremaine LLP and former specialist in HIPAA law at HHS.
Meaningful use requirements to share information are going to be the most challenging from a privacy and security perspective, Greene said. For now, while providers are still working under the stage 1 requirements, the problem is relatively small. Even when the industry moves to stage 2, it won't be too difficult as the data-sharing requirements of these stages focus mostly on Direct transfer, which is essentially a version of secure email. Greene said that most providers are prepared to deal with the privacy considerations at this stage.
But as the industry moves beyond Direct, this may get more challenging. This is because more advance query-based forms of HIE represent a loss of control over data for practices, Greene said.
"HIE is going to be one of the largest impacts on privacy of anything," he said. "It changed the whole privacy model."
Greene also cautioned providers against believing that meeting the meaningful use objectives means they are in compliance with all HIPAA privacy and security regulations. There is a lot of overlap between the two sets of criteria, but they are not exactly the same.
For example, both rules require physicians to make copies of records available to patients upon request. But meaningful use only directs doctors to supply the basic medical records. HIPAA, on the other hand, also requires providers to give patients billing, payment and other administrative records.