It's also been suggested that HHS is spinning EHR adoption numbers in order to tout the success of meaningful use, while others in the EHR debate see meaningful use and other regulations-including a Massachusetts rule that, as of 2015, ties medical licensure to meaningful use attestation-as an "external mandate" that only makes the practice of medicine "increasingly difficult."
Why are physicians so unsatisfied with the EHR systems they have? There are a few key reasons.
EHR Systems Don't Meet Physicians' Mobility Needs
First, contrary to popular opinion, physicians aren't Luddites. The vast majority own smartphones and many also have tablets. They want to use them at work. But they can't. Admittedly, some challenges stem from bring your own device (BYOD) security concerns, which are of greater concern to healthcare organizations than other enterprises given the sensitive nature of patient data.
The bigger issue is that EHR vendors have been slow to adapt their systems to mobile devices. A recent Black Book poll suggests that physicians want to use mobile EHRs to access patient data but find that most offerings fall flat. EHR vendors can't change smartphone screen sizes-physicians' biggest complaint-but they can build apps with intuitive, touch-enabled interfaces instead of simply moving what's often a legacy interface on the desktop to a mobile device.
Meaningful Use Threatens to Leave Many Doctors Behind
Next year begins stage 2 of meaningful use. It's more difficult than stage 1, as it progresses from simply using an EHR system to beginning to share information from that system with other healthcare providers.
Many organizations aren't ready. According to the Accenture survey, the following five features represent the least used EHR functionality:
- Electronic communication to support remote consultation and diagnostics.
- Electronic notification that a patient has interacted with another healthcare organization.
- Electronic communication with clinicians in other organizations.
- Use of clinical decision support systems to help make diagnostic and treatment decisions while seeing patients.
Each seldom-used feature gets to the core of information sharing and is therefore central to meaningful use stage 2. But these functions are seldom-used for a reason, Safavi says&mash;not every patient encounter requires higher-order decision support based on genomic research or an exhaustive study of drug efficacy.
That said, the meaningful use learning curve is hitting solo physician practices hard. In the wake of penalties for not using an EHR system, they increasingly face the prospect of joining a larger healthcare delivery network-and therefore losing coveted independence-or closing their doors for good.
As a result, there's been a call for a meaningful use stage 2 delay. The movement has six Republican senators on its side, as well as the American Medical Association and the College of Health Information Management Executives, which says a delay will help improve EHR functionality and interoperability.
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