Electronic Health Reporter

Guest post by Andy Nieto, health IT strategist, DataMotion.

The HITECH Act’s goal of improving clinical outcomes for patients using technology through meaningful use is admirable and quite overdue. However, where the Office of the National Coordinator for Health Information Technology (ONC), and to a much greater extent, electronic health records (EHR), have missed the mark is in the deployment and execution.

The stated goal of meaningful use Stage 1 (MU1) was to deploy, integrate and use EHRs to gather and document “structured and coded” healthcare data. Rather than take ONC’s directives as a framework to improve provider care tools, they viewed it as a “minimum requirement” and missed the spirit of the initiative. EHRs remain cumbersome, challenging and inefficient.

Providers now spend more time clicking boxes and typing than they do speaking to their patients. To make matters worse, the data gathered is maintained in the EHR’s “unique” way, making exchange and interaction challenging and interfaces costly.

Meaningful use stage 2 (MU2) is focused on interaction and interoperability. Unfortunately, the MU2 standard measures only “transitions of care.” Clearly, ONC is attempting to enhance communication between the multiple providers patients tend to have. However, these are not the only opportunities for improvement.

Real adoption of a technology comes from regular use and the opportunity to integrate it in innovative and effective ways. EHRs have once again failed to grasp the point of the law and have pigeon-holed this technology as a single purpose function, yet its familiar email-like structure and ubiquitous integration across all EHRs provides ample opportunity for multiple uses.

ONC made a pretty bold statement when it crowned Direct as its communication channel of choice. The PKI (public key infrastructure) architecture is a standard by which the simultaneous goals of encryption and identity validation can be achieved. However, PKI is not without its own shortcomings: The costs incurred and expertise required to manage, store, validate and administer the digital certificates are high, making this an expensive decision. The Direct Trust and its certification partner, EHNAC (Electronic Healthcare Network Accreditation Commission), have established rigorous standards and measureable structure for HISPs (Health Information Service Providers) who facilitate Direct.

Direct holds the key to eliminating costly point-to-point interfaces for labs, devices, clearing houses, registries and other clinical systems. With dedicated point-to-point interfaces costing upwards of $10,000 each, a small practice or solo provider cannot hope to afford the best integration of technology. With Direct, a provider could communicate with the lab or labs of their choice without having to be concerned with the interface.

Direct senders and recipients must be identity-validated to receive their digital certificate. This provides a unique opportunity when sending documents and letters. No longer would there be a concern that a patient’s information could be faxed to a wrong number. If a recipient could not be validated, the message would not be sent. HISPs also have the ability to block sender’s certificates if needed. Spam is also likely to see a decrease, because of the cost associated with attaining a certificate and the complete lack of anonymity with Direct.

As providers and practices become more technologically savvy, they will begin to demand functionality beyond just meaningful use. End user adoption is the key and by making the solution intuitive, effective, and most of all, easy to use, it will assure that the technology is actually useful. Open standards, truly integrated messaging and clear paths of interaction, not just transitions of care, are our future.