NEJM: Does meaningful use equal meaningful benefits?
 |
“Another major issue is who will produce the needed innovation for these new tools, since the vendors are far too busy meeting deadlines to innovate, and even the organizations that have historically filled this role are considering switching to vendor applications,” wrote authors David C. Classen, MD, from the department of internal medicine at the University of Utah School of Medicine in Salt Lake City, and David W. Bates, MD, from the division of general medicine and primary care at Brigham and Women’s Hospital in Boston.
“Providers that qualify for the meaningful use incentives will not necessarily achieve meaningful benefits, so that the links with other parts of healthcare reform, which will directly provide incentive for those benefits, are critical,” they added.
According to the authors, although meaningful use as a concept is attractive, the jury is still out whether the standards being established will result in improvements in care. They also noted that the adoption of the HITECH Act and meaningful use is intended only as a starting point.
“Success in improving care with EHRs may be related to the type of EHRs that are used, their settings of use and the incentives in place,” Classen and Bates wrote, adding that most studies of the successful effect of EHRs on quality and safety of care have come from four organizations that use internally developed EHRs that have been in place for more than 25 years:
- Brigham and Women’s Hospital in Boston;
- LDS Hospital in Salt Lake City;
- Vanderbilt University Medical Center in Nashville, Tenn.; and
- Regenstrief Institute in Indianapolis.
“All four institutions have spent decades expanding, iterating on and improving their EHRs and have shown improvements in safety, quality and efficiency,” they wrote. “Because these systems are under local control, the EHRs have been highly customized with the use of relatively rapid improvement cycles. They also have built informatics cultures of continuous quality improvement that allow for ongoing evaluation and iterative improvement. However, such cultures have not been widely replicated in other organizations, and vendor applications do not facilitate customization to nearly the same extent.
“Getting the full benefits of EHRs will be especially hard for organizations that do not have the experiences of the pioneers, and this will be a particular challenge in primary care settings and smaller hospitals, which do not yet have cultures focused on health IT and improvement and are using less-developed vendor systems,” wrote the authors.
Classen and Bates concluded with three recommendations:
- Providers must go beyond making sure they qualify for the incentives and track whether they have the tools necessary for improving efficiency, quality and safety;
- Testing after implementation will be essential to ensure the safety and effectiveness of clinical information systems in actual use; and
- Federal research support is needed to ensure that continued innovation, improvement and safe implementation of these complex EHR systems actually occur and do so in a way that promotes safety and quality of care.