Mismatch Between Meaningful-Use Criteria and Clinical Practice

Mismatch Between Meaningful-Use Criteria and Clinical Practice
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Our health care industry has evolved dramatically over the past few decades. It is definitely not the same as it was 50 years ago. As the IT industry progressed it was quickly adopted by physician widely.

The use of EHR in health care industry was profoundly used during the 1980s. recording patient’s data, keeping a list of medical bills and drugs. All of this was done on computers. Hospitals and medical providers used IT to manage complex and lengthy records in one system. For this different kind of health care applications were developed to support the data of the hospital.

Meaningful use of EHR incentive program In recent decades EHR has completely changed the health care industry. It is called the heart of health care industry and nearly all physicians rely on EHR. From recording patient’s history to communicating data from one hospital to another or Gathering every evidence related to a medical presentation is made possible with just a few clicks. EHR has replaced paper based patients records to enable better integration and collaboration among different health care providers. The hospital organization has believed that the IT would tremendously benefit our health care and invested millions in development of softwares along with the training of health care providers.

It has promised; - Feasibility - Validity - Reliability


PHR (patient healthcare record)

As the health care industry progressed the idea of “patient centered care” was also put forward. The health care information technology can direct their objective around patient care and can play an important role in regulating it. This can be done by;

  • Clear communication and precise information exchange between attendants / caretakers, patients and clinicians.

  • Coordination and cooperation between healthcare care providers for the care on patient.

PHR is not just a collection of patient’s data but it is a combination of IT, patient data and medical knowledge. The goal of PHR is to actively engage patient in their own care, they have a right to know the cause, condition and stage of their disease. PHR combined with the EHR gives highest efficiency of results in patient care.

Benefits of PHR - To share lab and test results. - To share drug and medication information - To schedule an electronic appointment - Telehealth/ E-visits - Directly email or send message to doctor

E-health/ M-health (mobile- health) The concept of engaging patients has been appreciated by physicians and patients alike. New applications and software are made or in the process of being made to make healthcare more and more easily accessible even to remote individual. Especially during the times of Covid, the health care industry has shifted more and more towards e-health or m-health.

E-health has a broad range spectrum of health care softwares and applications that facilitate management and efficient delivery of health care. It is a combination of electronic communication and information technology in healthcare. Every year new apps and softwares are introduced to provide and record precise, to the point information about patient’s history.

Challenges in the health care system If we look at a medical provider’s point of view, there are many possibilities of achieving the highest standard of medical care in adapting clinical treatment. This includes; - Reducing the time of medical record keeping - Improving workflow and efficiency - Shared medical information among different medical providers and patients - Quick access to updated changes in medical record - Availability of accurate clinical data and case studies - Easily summarized clinical data of every patient - Precise and better clinical decision making - Reduced chances of mistakes in medical record making

However, there are still many barriers to cross and many challenges to face in the development of an state of art medical technology. Despite the continuous development of new softwares and applications, there are certain drawbacks that still need to addressed even in this decade. Healthcare IT is becoming a crucial part of our field, health care providers have to use it religiously so the errors and mistakes need to be corrected. This helps reduce physician burnout and saves clinical time.

Clinicians have hectic nature of clinical work. On duty clinicians tend to be busy including interruption by emergency cases. For this reason, they are left with very little time and opportunity to spend long hours on computer.


Lack of inter-operability

Let me first explain you what is interoperability. “so interoperability is the ability to effectively and easily share data that is important for each individual care” effective interoperability isn’t just sending anything and everything but making sure that providers are able to send and receive exactly what is needed to make informed decisions about their patients care and to be able to do so within their workflow.

It’s been a decade since the health care organization and hospitals have widely adopted the EHR. Despite the advancements there are still many obstructions in the achievement of high efficiency. Interrupted interoperability in EHR makes excessively difficult for medical providers to participate in value based information.

Changes should be made in advancing EHR as a patient centered system. Its core should really support the empathetic interaction between patients and providers and in doing so technology should make providers more efficient at delivering the care that they need and that should enable providers to deliver better health care with higher quality.

It should also enable patients to be empowered and engaged in their health care. This is the core to the application layer that interoperability and technology can create. The data gained by EHR system does help in empowering patient but sometimes it’s far from reality. Instead of providing benefits it creates inefficiencies for the health care providers. Our healthcare lacks an interoperable infrastructure. It’s really this technology down here below this line that isn’t directly interacting with patient care.

In other words, technology has really not enabled a better healthcare environment that was hypothesized. Health care technologist obsess over how to make technology adoption more seamless. However, it didn’t come easy to health care the way we saw electronic health records cross the technology adoption a decade ago. Instead of having a 10x improvement on technology, government put forth billions of dollars in subsides to the hospital and to eligible provider to adopt electronic health records and pulled them across the chasm to where we are today with near ubiquitous adoption of technology. So what we missed is that improvement that would have probably created electronic health records that could be built on cloud to save data from burning out in hard drives.

It could be built on a user centered infrastructure to improve the user experience. From an interoperability point of view, we do have electronic health records but we need more technology in order to hit opportunities for efficiency gain.

Failure in implementation of devised system and rules EHR is an electronic health record and an electronic copy of patient’s paperwork chart. It provides sharing of medical documents between multiple organizations. EHR is a plan that has been implemented into comprehensive strategies. These steps are used by healthcare facilities to prepare executing adaptations of electronically based healthcare system.

  • We have an implementation team. It consists of all members of organizations leading to major roles. The project manager manages the implementation process of providing assistance with vendor cost, deadlines and any issues created by the system. He/she works alongside the lead physician and health care staff resolving the legal and technical issues. User role is identified as brain of information process team builds new software, develops the program and helps with the hands-on-assistance with working on an EHR system.

  • Next up you’ve to build a software risk assessment program. While building a software for your practice health care vendors should make your system is secured to practice under the needed requirements. Optimizing workflow by customizing software for your physicians needs such as patient demographics, medical management disease types and other titles that will allow you to practice. We need to look into different options for the best cost friendly implementation process possible for you practice.

  • Then comes the presence of required hardware specifications in organization. Having proper system can save from long term trouble and money.

  • Another step is transfer of current data to determine how and when the organization wants to transfer the information to new system. With this organization can determine to use current staff or hire team. Having seamless workflow bring patient value allowing organizations to plan accordingly. Failure in any of these steps or mismanagement leads to inefficient use of EHR. Other causes of EHR failure include;

  • It requires huge investment

  • Due to lack of efficiency it data is not standardized

  • It is fairly difficult to operate and takes out a lot of clinical hours Lack of user involvement For the successful intervention of an EHR incentive system user experience is the foremost most important criteria. Ease of user experience is the primary goal of electronic health care system.

Currently there are numerous applications built to provide ease of access to the end user. Be it a medical provider, caretaker or patient, main aim is to deliver information and data easily to the user with less clicks and reduce navigation through different options.

Technologist should be teamed up the healthcare providers to build a user centered design of the software in such a way to merge technology and medical interventions and results. Four methods can be incorporated to obtain feedback by the end user; - Email - Questionnaire - Evaluation of usage and usability - Short interview and asking for feedback

Inability to use system by medical providers There is not a single physician who is happy with the meaningful EHR system. Although electronic records are really helpful in storing and optimizing patient data. It has its major drawbacks that need to be assessed. EHR has negative impact on physician’s professional lives causing trouble in patient care. The EHR usability does not match with their clinical hours. It has a long tiring process of entering the patient’s data, navigating through different options, unable to find what you are looking for, numerous clicks and poorly designed application. It just creates exhaustion and burnout. Plus, it affects the professional life of physician as he/she isn’t able to spend more time practicing with patients. Clinicians spend 510 minutes on patient physically and 25/ 30 minutes entering data into the system.

Improvement should be made in training the medical providers to use the software. Obviously making an entirely new software and transferring data on it requires a lot of time and budget. So we have to train physicians to use the provided software instead of longing for an updated one.


Take away

Even after so many advancements in the health care technologies, the development of this system is in worrisome condition. Millions of dollars are wasted on diverse IT systems that tend to be poor in functionality and inoperable by individual. EHR, PHR and e-health/m-health did revolutionize the overall perspective of healthcare system by shifting from paper records to easily accessible, quick, summarized online medical records. There is continuous mismatch between the meaningful use of EHR and clinical practice that just seems impossible to reduce or eliminate.

To determine the efficiency of ICT applications we should compare the healthcare domain to other domains and then implement user centered strategies to design the system. We should compare the software with the devices that are extensively used by the user like smart phone, tablets and laptops.

This can be done by; - Specifying user use and requirements - Design solutions that are widely appreciated by majority of users - Evaluation of design by launching beta software to a controlled group of users

There are many challenges to be faced by the medical practioners in the usability of meaningful EHR incentive software e.g. lack of usability and interoperability, failure to implement the system, untrained individuals and poorly designed infrastructure. It takes a lot of time and money to develop a new system. So the health industry should focus on training the medical providers with the existing software. This way it will take a lot less time to enter the data while new updates are in progress.


REFRENCES

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802309/

https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1146&context=publichealthresources

https://www.cio.com/article/2369036/does-meaningful-use-need-an-overhaul.html

https://www.bmj.com/content/343/bmj.d6054

https://aaltodoc.aalto.fi/handle/123456789/5041

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2011.1315

https://www.healthaffairs.org/do/10.1377/hblog20140311.037786/full/

https://bulletin.facs.org/2012/07/health-information-technology-meaningful-use-criteria-and-their-effects-on-surgeons/

https://www.aha.org/sites/default/files/hospitals-face-challenges-using-electronic-health-records-to-generate-clinical-quality-measures.pdf

https://link.springer.com/article/10.1007/s11606-017-4030-1

https://www.ncmedicaljournal.com/content/76/4/230.short

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347738/

https://www.nist.gov/system/files/documents/2017/05/09/NIST-IR-7865.pdf

https://sci-hub.ee/10.1007/s11606-014-3049-9