In 2008, as the U.S. economy tanked, Congress passed a $700 billion stimulus package to fund ‘shovel ready projects’ to put Americans back to work and America back on its feet. They specifically designated $30 billion to wire the American healthcare system. The Office of the National Coordinator was created to manage the digital transition and Meaningful Use came to life. The idea, of course, was that the investor (the U.S. Government as a proxy for the U.S. Taxpayer) must see a return on investment in the form of demonstrated use of the technology it had just funded, thus ever increasing strings were attached to Meaningful Use incentive payments. The $30 billion fund will be exhausted by year end 2014. The compliance carrot of increased revenue is progressively being replaced by the threat of penalties for noncompliance. Now what?
As my friend and colleague, Mike Stoecklein, is prone to say about particularly complicated hairballs like this, “I don’t know the answer but I certainly admire the problem.”
Has Meaningful Use been successful? It all depends on who you ask and what measuring stick is used.
If spending is a proxy for technology implementation, we’ve done well. The $30 billion is nearly gone.
If installation of technology is a proxy for improvement, then we’ve also made major strides.
If higher quality patient outcomes and lower cost are the litmus test, we’ve failed miserably.
The 2014 Report to Congress clearly indicates more doctors and many more hospitals have installed and are now using electronic medical records as a result of Meaningful Use implementation. This came at enormous cost (turns out you can spend $30 billion pretty quickly) but it could be a really big deal. Could, of course, being the operative word.
Wiring the hospital or clinic for internet, installing an electronic medical records system, putting secure computer monitors and keyboards in the exam room - are the costly and potentially useful – or potentially useless – artifacts of Meaningful Use. The idea that implementation of EMRs could result in improved care delivery and high quality patient outcomes is tempting, but the assumption that more technology will result in improved care delivery and patient outcomes is a big one. The further assumption that the mere existence of EMRs will drive down costs is also a big leap. Too big of a leap.
There is truth in the adage, “What gets measured and reported gets improved.” In the case of MU, what is measured is the organization’s implementation of technology. Patients do not benefit from the implementation of technology. Rather, patients benefit from ready access, speed of correct diagnosis, an effective care plan, and the genuine compassion they receive from a caring and qualified provider. Electronic medical records and other technology can enable such actions, but are in no way a substitute for a knowledgeable, accountable, and motivated human being whose sole focus is the patient experience.
The real measure of success of Meaningful (to the patient) Use (of technology) is whether the implementation of EMR technology has enabled higher quality, consistent, and efficient care that improves patient outcomes and lowers cost.
What must be done to assure the $30 billion Meaningful Use investment results in real impact to patients? Think first about what the patient really needs to have an optimal experience. Then consider what the care givers need to deliver that experience. These are your Key Performance Questions. Next, ask what information and in what format would help the care giver and patient perform at the highest level? What training does the front line worker need to receive in order to understand and take appropriate action with that information? Then, finally, consider how an electronic medical record and transparent performance reporting system can support that work. The power of this strategic connection will have real, long lasting, and truly meaningful impact on patients.
The Triple Aim is not a goal that can be achieved by the mere investing in technology.
Transformational-level continuous improvement can only happen when trusted and actionable information is delivered in an understandable format and in time to inform the decision being made by a care giver or patient who is knowledgeable, empowered, and motivated to take action. Anything less is waste.
Meaningful Use provides the technology platform for the capture and sharing of information that is essential to continuous and sustained improvement.
A culture of continuous improvement brings the discipline of scientific thinking, the enthusiasm for problem solving, and the spread of best practice to life in the front line every day.
Mindfulness assures there is never a proxy for the human and humane aspects of patient care.
Try it. Just try it.
1. 2014 Report to Congress. http://www.healthit.gov/sites/default/files/rtc_adoption_and_exchange9302014.pdf
2. Triple Aim. http://content.healthaffairs.org/content/27/3/759.abstract
3. Mindfulness. http://bit.ly/1w3K4j9