I’ve been advocating for years that replacing the paper chart with an electronic system is not the value of the EHR, but rather collecting data that can be used to understand and improve care. So I was very pleased to see Dr. John Showalter’s blog address this very issue – making a compelling case with real-world examples where wisdom derived from data has made demonstrable improvements in healthcare quality and corresponding reductions in cost.
However, I would add to Dr. Showalter’s compelling narrative the perspective that collecting and analyzing data is not enough – the data also needs to be of consistently high quality, reliable and trustworthy to be genuinely valuable.
Before HITECH and meaningful use, the return on investment analysis for EHR applications was all around upcoding encounters to increase billing (and generating pages of “robo-notes” that drive physicians nuts) or saving the cost-per-square-foot of space in medical records by eliminating paper. No wonder the adoption rate for EHRs was so low! Over the past several years, HITECH has been great in getting even the most stubborn organizations to move to adopt EHRs, but we unfortunately haven’t made much progress as an industry in putting the proper focus on the value of the data. Instead we talk in terms of getting meaningful use dollars and avoiding penalties. But meaningful use is also very valuable in that it establishes a quality standard for the data that is collected – defining the fields, the formats, the clinical vocabularies and whatnot that will make the data incredibly useful in the aggregate for analysis.
Dr. Showalter also references several studies that call into question the value of EHRs in improving quality and reducing costs. These studies and their results should not be surprising if we recognize that all EHR implementations are not created equal. In years past, it was considered a valid strategy to implement an EHR application across an enterprise, but not standardize practices and data across different departments or even different physician practices – it was just too hard to change the healthcare culture that valued the independence and flexibility of paper. In this context it should not be a surprise that studies show older EHR implementations have not delivered much value. In some instances this is attributable to not enough time having elapsed for analytics on the data to have matured, since even the most robust and well-implemented EHRs take time to collect enough to data to generate useful wisdom and insight. In other cases, I expect EHR implementations may have successfully replaced paper, but did so without universally applied data standards and governance to ensure the data was reliable, trustworthy and useful for analysis.
HITECH and meaningful use helps ensure current EHR implementations yield data suitable for analytics by strictly defining a minimum standard of data quality for a small subset of data elements. But to really realize the power of the data contained in the EHR, and differentiate themselves on healthcare value, organizations should look to standardize and govern the quality of not just those data stipulated by meaningful use criteria, but all the data in an EHR. Only then will we be properly focused on the wisdom and potential to improve healthcare that exists in the data, and have our collective eye on the real value of the EHR.