Paul Brient

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	The Medicare Access and CHIP Reauthorization Act (MACRA) has rocketed to the top of the list of near-term regulatory challenges for healthcare providers. Because MACRA addresses healthcare payments, quality, 

 information technology (IT), understanding and complying with it demands attention from clinicians, administrators and IT professionals alike.

	Even under ideal circumstances, the shift to value-based reimbursement espoused by MACRA would be challenging-and circumstances are far from ideal. For one thing, there is uncertainty surrounding the American Health Care Act (AHCA), which is rattling around in Congress. Just as significantly, healthcare still is dealing with its last IT mega-challenge: adoption and effective use (not to be confused with Meaningful Use) of electronic health records (EHR) systems.

 found that nearly two-thirds of all physicians feel unprepared to manage and execute MACRA. This is understandable, given that so many physicians continue to wrestle with poor usability and related workflow implications of EHRs, and hospital IT organizations continue to place “EHR optimization” above MACRA implementation on their 

	There are multiple factors contributing to the EHR distraction. As one media outlet 

, “Many people blame the HITECH Act and its meaningful use EHR program for incentivizing software vendors to craft products that meet the federal government’s specific criteria at the expense of innovative features and functionality.” The article quoted a health IT industry executive who stated, “In many cases, EHRs that were designed pre-MU, and originally had high user satisfaction, were redesigned to obtain MU subsidies and, subsequently, user satisfaction dropped.”

	Here are three EHR-related challenges that are impeding the advancement of IT support for value-based reimbursements:

. EHRs are everywhere, but liked (at least by physicians) practically nowhere. Thanks to Meaningful Use, nearly 

 of hospitals are now using a certified EHR platform. Regardless of where a physician practices, they have to use the technology, like it or not.

. Regardless of the high-adoption numbers, EHRs still place a heavy productivity burden on physicians. In theory, EHRs should make providers more efficient, streamline their workflow, and allow them to spend more time with patients. Instead, EHRs are the 

 of U.S. physicians, three out of four doctors believe EHRs increase costs, outweighing any efficiency savings. Seven out of 10 also believe that EHRs reduce their productivity.

	It is now clear that the federal government’s programmatic push behind EHRs forced immature technology upon providers. The systems simply were not (and, for the most part, still are not) ready for prime time. It is unlikely that the technology underpinnings of value-based reimbursement will be firmly in place until the EHR mess is cleaned up.

	So what should be done? For starters, we need to make the EHR as intuitive, integral and indispensable to patient care as, say, the stethoscope. This will take work and imagination. The current generation of EHRs fell victim to the “automate what is there” problem. Almost all EHRs present the same information, the same way, regardless of the specialty of the user, the patient situation, or the care setting. This is because these EHRs are modeled after the paper chart. It is impossible to make a paper chart dynamically adapt and present the most pertinent information given the situation, but it is very possible to have computers do this.

	While new value-based payment models certainly hold immense promise from both a cost and quality perspective, having the right technology in place for clinicians is the first crucial step to success. Only by making clinicians more efficient and effective will value-based payment models pay off for health systems. And it is in everyone’s interest to make it happen.

He brings more than 20 years of experience in healthcare information technology including physician workflow automation, physician practice automation, payer-based medical management, pharmaceutical-based disease management and medical devices.

Articles

Here are 3 EHR-related challenges that are impeding the advancement of IT support for value-based reimbursements.

Paul Brient

Articles

Three EHR challenges hindering value-based reimbursement