[{"innerBlocks":[],"name":"core\/freeform","postId":4764,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Never one to mince words, John Halamka, MD, CIO of Boston\u2019s Beth Israel Deaconess Medical Center issued a wide-ranging call to action for healthcare information technology, including electronic health records, big data and analytics, cloud and mobility solutions.

Delivering the opening address at a pre-conference symposium entitled \u201cAre We There Yet? Health Information Technology\u2019s Report Card,\u201d Halamka declared that the Meaningful Use program has \u201crun its course\u201d and that the healthcare industry must move away from the EHR Incentive Programs to outcomes based payment models for clinicians and hospitals while embracing new reimbursement approaches.

While EHRs had been \u201cperfectly engineered\u201d to meet regulatory requirements, he evaluated the performance of these systems to date giving them a C+ grade overall. The problem, according to Halamka, is that in order for a clinician to get through a patient encounter and be Meaningful Use Stage 2 compliant they must enter 141 structured data elements to calculate electronic quality measures that \u201cprobably aren\u2019t going to be used.\u201d

When it comes to EHRs, he asserted that \u201cwe need to look at what we\u2019ve done to ourselves\u201d in terms of efficiency, workflow, and physician satisfaction and soberly assess whether the healthcare industry is able to achieve the outcomes that these systems were meant to enable\u2014better care coordination.

\u201cWe need everyone to work at the top of their license, and clinicians {working) as data entry clerks is not the top of their license,\u201d Halamka said. \u201cYou have 12 minutes to see the patient, 140 structured data elements to enter, you have to of course never commit malpractice, and make eye contact. It\u2019s not possible.\u201d

Despite the fact that more than three-quarters of U.S. hospitals and half of outpatient practices have installed EHR systems, Halamka lamented the fact that 40 percent of physicians feel burned out. \u201cLook at Meaningful Use Stages 1, 2 and 3; it\u2019s as if we\u2019ve been running a marathon every day for the last seven or eight years, and we are tired,\u201d he said. \u201cWe must reduce clinician burden.\u201d

Further, Halamka charged that health IT certification in its current form paralyzes innovation and does not improve interoperability. What\u2019s needed, he said, are a national provider directory, a voluntary national patient identifier, a trust fabric, a governance framework and consistent privacy policies.

\u201cMeaningful Use was very important in its day, Moving us to at least a floor of functionality, Stage 1 was good.\"<\/bsp-quote>\u201cMeaningful Use was very important in its day,\u201d Halamka contends. \u201cMoving us to at least a floor of functionality, Stage 1 was good. The problem is we tried to move too far, too fast before we had the cultural change or the enablers like a patient identifier, the provider directory or trust fabric.\u201d

At the same time, he advised that it\u2019s time to return innovation to the private sector, noting that he doesn\u2019t blame EHR vendors for the shortcomings of these systems. \u201cIt\u2019s not that the vendors delivered bad products or unusable products. It was that we demanded them have to have certain functions, and that created a level of stress and lack of usability and suitability of purpose,\u201d Halamka told the HIMSS audience. \u201cIf you were to coordinate team-based care between the primary care provider, a specialist, patient and family, inpatient\/outpatient, urgent care, would it be easier in your EHR or Facebook? Most people actually say Facebook.\u201d

A secure Facebook-like social networking application would be better than EHRs for bringing together patients, families and physicians, Halamka reported that he told the Centers for Medicare and Medicaid Services. The response from CMS, he said, was that it would \u201cviolate 300,000 pages of regulations.\u201d As a workaround, Halamka countered that doctors, \u201cat the end of the day, could cut and paste the Facebook entries and insert them into the EHR.\u201d

According to Halamka, 80 percent of Beth Israel Deaconess Medical Center\u2019s public-facing assets such as PHRs, websites and social media are accessed on mobile devices. \u201cThe desktop is dead,\u201d he opined. \u201cThis is the way patients and families want to navigate their care, using middleware on their smartphones to gather the data to push it to and from the doctor.\u201d

As an example, Halamka referenced an initiative at Beth Israel Deaconess Medical Center called MyICU, a new communication tool designed for ICU patients and their families that takes raw health data and presents it in a dashboard on iPads.

\u201cI actually do feel better about patient and family engagement,\u201d he commented, giving the technology category a B grade. \u201cI look at all the major vendors and their PHRs and the fact that if patients want to get to them, they can.\u201d

Similarly, Halamka gave B grades to big data\/analytics as well as mobile\/cloud applications. \u201cThe big challenge with mobile and cloud are the lawyers,\u201d whom he said tend to be wary of the risks involved and are fearful that systems might be compromised or go down. Nonetheless, Halamka believes that outsourcing to the cloud actually reduces risk through system redundancy offered by commercial public providers. \u201cRisk can never be zero but we\u2019re heading in the right direction,\u201d he asserted.","saveContent":"Never one to mince words, John Halamka, MD, CIO of Boston\u2019s Beth Israel Deaconess Medical Center issued a wide-ranging call to action for healthcare information technology, including electronic health records, big data and analytics, cloud and mobility solutions.

Delivering the opening address at a pre-conference symposium entitled \u201cAre We There Yet? Health Information Technology\u2019s Report Card,\u201d Halamka declared that the Meaningful Use program has \u201crun its course\u201d and that the healthcare industry must move away from the EHR Incentive Programs to outcomes based payment models for clinicians and hospitals while embracing new reimbursement approaches.

\u201cMeaningful Use was very important in its day, Moving us to at least a floor of functionality, Stage 1 was good.\"<\/bsp-quote>\u201cMeaningful Use was very important in its day,\u201d Halamka contends. \u201cMoving us to at least a floor of functionality, Stage 1 was good. The problem is we tried to move too far, too fast before we had the cultural change or the enablers like a patient identifier, the provider directory or trust fabric.\u201d

At the same time, he advised that it\u2019s time to return innovation to the private sector, noting that he doesn\u2019t blame EHR vendors for the shortcomings of these systems. \u201cIt\u2019s not that the vendors delivered bad products or unusable products. It was that we demanded them have to have certain functions, and that created a level of stress and lack of usability and suitability of purpose,\u201d Halamka told the HIMSS audience. \u201cIf you were to coordinate team-based care between the primary care provider, a specialist, patient and family, inpatient\/outpatient, urgent care, would it be easier in your EHR or Facebook? Most people actually say Facebook.\u201d

A secure Facebook-like social networking application would be better than EHRs for bringing together patients, families and physicians, Halamka reported that he told the Centers for Medicare and Medicaid Services. The response from CMS, he said, was that it would \u201cviolate 300,000 pages of regulations.\u201d As a workaround, Halamka countered that doctors, \u201cat the end of the day, could cut and paste the Facebook entries and insert them into the EHR.\u201d

According to Halamka, 80 percent of Beth Israel Deaconess Medical Center\u2019s public-facing assets such as PHRs, websites and social media are accessed on mobile devices. \u201cThe desktop is dead,\u201d he opined. \u201cThis is the way patients and families want to navigate their care, using middleware on their smartphones to gather the data to push it to and from the doctor.\u201d

As an example, Halamka referenced an initiative at Beth Israel Deaconess Medical Center called MyICU, a new communication tool designed for ICU patients and their families that takes raw health data and presents it in a dashboard on iPads.

\u201cI actually do feel better about patient and family engagement,\u201d he commented, giving the technology category a B grade. \u201cI look at all the major vendors and their PHRs and the fact that if patients want to get to them, they can.\u201d

Similarly, Halamka gave B grades to big data\/analytics as well as mobile\/cloud applications. \u201cThe big challenge with mobile and cloud are the lawyers,\u201d whom he said tend to be wary of the risks involved and are fearful that systems might be compromised or go down. Nonetheless, Halamka believes that outsourcing to the cloud actually reduces risk through system redundancy offered by commercial public providers. \u201cRisk can never be zero but we\u2019re heading in the right direction,\u201d he asserted.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Halamka: Meaningful Use has run its course

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