Two big issues we face in 2015 are Meaningful Use (MU) and ICD-10—both contentious in that they aren’t measuring up to their promise. Yet, efforts to promulgate an interoperability standard and other developments indicate we should not give up hope.
The low numbers of successful MU Stage 2 attestation do not surprise me. An EHR system is an important step in the process of digitizing healthcare, but nothing else is constructed. It’s like a house that has a finished, gorgeous living room but no kitchen, bedrooms or bathrooms.
Stakeholders must understand that MU is just one step to achieving interoperability.
Regarding Stage 3, the promised early 2015 release of a proposed rule could still happen because it’s easier to finish the legislation than execute the legislation. If things become too politically toxic, we could postpone the issue until the next administration. The federal government isn’t going to battle with every healthcare system that isn’t MU-compliant because that’s not a good political disposition for the next election cycle. Yet, if hospitals as a group yell loud enough about pain and difficulty, they’ll get some relief and we’ll readdress the issue in two years.
Health Level 7’s FHIR standard has taken off because it’s a direct shot at one of the biggest criticisms of modern-day EHRs—their inability to interoperate. Hope springs eternal so changing attitudes along with new technologies and techniques available now may make this a lot easier this time around.
The idea of beta interoperability and health information exchange is not a little detail of transport and transfer. It’s a much bigger issue. I spoke to a CIO at a big system who forbade community physicians practicing at his organization from downloading information from his EHR into their office system. People like him cite confidentiality and liability concerns in their fight against interoperability and information exchange. That speaks to all of the dysfunction in American healthcare today.
Meanwhile, feelings about the ICD-10 transition range from people who think it would be irresponsible and unsafe not to move expeditiously to the new codeset because it is more complete and detailed to those who want to put a stop to all efforts and move to SNOMED instead. There has been tremendous traffic on the AMDIS listserv on this. ICD-10 has been touted as an opportunity to help us learn more about our patients and leverage data cohorts. The reality is that it’s just the way Medicare and other organizations know how to bill and pay you for your services.
Another delay is possible but not likely. I think, however, that if the government tells providers they won’t get paid unless they submit claims using ICD-10 codes, there will be so much legal activity it will make everybody’s hair turn white. We are just exhausted with meeting all of these mandates.
Healthcare requires a lot of repair work because the consequences of our past efforts are now pushing political discourse. With all the disruptive yet planned-for activities both within and outside the informatics community on our plates, we still have more than one hill to climb.