Meaningful Use And Health IT Innovation

Today I caught an excellent post on HIT Consultant by standards architect Keith Boone (aka @motorcycleguy on Twitter) on how Meaningful Use is affecting health IT. In his article, Boone argues that Meaningful Use requirements are stifling health IT innovation in some instances:

When you put an entire industry under the MU pressure cooker, the need to meet Federal Mandates overwhelms anything else.  The need to develop software that is able to support a large number of externally controlled mandates can, and in many cases, has resulted in bad engineering.  You can’t innovate well on a deadline.

Boone says he’s seen many instances where developers produce a capability that meets MU requirements but doesn’t meet the needs of the customer. He suggests, quite credibly in my view, that with Meaningful Use requirements dominating EMR development, that “neither developers nor end users really learn the lessons Meaningful Use is attempting to teach.”

That being said, he does cite a few instances where Meaningful Use has actually succeeded in supporting innovation, including:

* The Blue Button Plus supports a new, higher level of patient access to their data,and is built from components and requirements already present in Stage 2.

* The Query Health initiative, he suggests, has done innovative work that supports not only its stated focus (health research) but also automation of quality measurement using HL7’s HQMF.

But the bottom line remains — and this is me talking here, not Boone — that Meaningful Use will inevitably focus EMR vendors on developing to the standard, not coming up with neat innovations that may not meet the requirement. There’s just no way around it.

What we will see more of, meanwhile, is applications which serve as an extra layer or function to EMRs. As a recent story in MedCityNews notes, new EMR-related innovations range from Modernizing Medicine’s touch-based electronic medical assistant for specialists to healthfinch, a technology which standardizes care protocols for the 80 percent of stable patients they see so they can apply their time and skills to the sickest 10 percent to 20 percent.

Readers, what technologies are you seeing which enhance the experience of using an EMR?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • “Readers, what technologies are you seeing which enhance the experience of using an EMR?”

    NONE. All the enhancements I see are aimed at MU or some form of P4P or audit to allow the institution to capture data and qualify for better reimbursement (or avoid penalties).

    In 5 years with m,y current institution, I cannot remember one instance where the clinicians were even asked what could be done to make the EHR easier to use in the room with the patient.

  • I’m sorry to hear about your bad experience with clinician involvement in growing the EMR’s capabilities. Did you ever go to your institution’s management and share ideas as to what you’d like to see, and if so was your feedback ignore?

  • I made a major effort over a period of years (since we went live in February 2001) to be involved. I was the Chair of a local users group until the group disbanded in frustration at being ignored. I was on the EHR and IT Steering Committees. I devoted countless (unpaid) hours to behind the scenes work, managing custom lists, writing letters, designing and fixing templates. I went to the annual national user’s meetings (on my own dime) to collect ideas and learn more. I took programming courses to improve my ability to contribute.

    At the beginning, I (and a core of others) were recruited, appreciated and heavily involved in decision making. As time went on, however, our involvement was marginalized to issues of how to deploy the decisions made by those who used the data. Those who actually use the EHR to care for patients are less and less involved.

    One example will illustrate well. Our outpatient EHR and inpatient EHR are from different companies and do not share data well. It was decided at a very high level (IT and business and board levels) to consider switching to an outpatient EHR that would be better integrated. A small group (including a minority of clinicians) worked in private to narrow the candidate EHRs to two, which were presented to the medical staff for ‘feedback’ with brief non-hands-on demos and no actual system for clinicians to provide concrete feedback. The existence of the project was not made known to the users until time for picking a new EHR from two options, and at no time were the users contacted to find out what worked well or poorly in the current system, and what should be sought in a new system.

    In my discussions with providers at other institutions, I get the impression that this is a fairly common approach.

  • I’m sure that Boone’s experience is not an anomaly. I think some of the problem lies with vendors who will build specific functions into their products MU without overhauling what are often poorly developed report writers.

    It’s a rare product that highlights its ability to pull data together for reporting. Most all emphasis is on an individual’s encounters, their history and current situation. The MU standards look at patterns across patients, which is precisely the opposite of how many EHRs have been configured. Both points of view are important and not mutually exclusive.

  • It is no secret that hundreds of vendors developed more hundreds of EMR solutions to qualify for MU funds. I’ve seen at least one “certified” EMR built entirely upon Microsoft Excel. Yet, innovation was stifled by some but not all.

    The big, slow players reacted to MU in entirely predictable ways while the newer, more agile companies created solutions that start and end with the physicians needs. The challenge is getting the physicians to stop believing it is “safe” to buy IBM and look at solutions from these innovators.

    I demonstrate every day solutions that were designed from day one to make life better for the physician and their staff. We have demonstrated that attesting for MU is mostly done in the background or seamlessly integrated into the workflow so it is serendipitous. We have moved on to create an ICD-10 solution that nudges physicians today to learn ICD-10 so next October is just another day. We completed our 2014 certification well ahead of the deadline. We are seamlessly interoperable at less than 300/mo, yet most physicians wont seriously consider our solution because we have only been in business four successful years.

    From where I sit, it is fear of making mistakes on the part of the physician that is far more egregious for stifling innovation. Better solutions exist because the vendors spend more money on R&D than marketing.

  • Part of the problem is this: EHRs where first created, then MU came along. The existing EHRs had to quickly adapt and much of that adaption ruined any efficiency that might have been in the interface. Now it takes 5 to 7 clicks to get one MU counter.

    Software vendors should do better, but they know switching is painful…

  • “what could be done to make the EHR easier to use in the room with the patient.”

    I have heard the same for 20+ years now.
    You don’t answer this question.
    You don’t resolve it, you dissolve it.
    It is a simple contradiction in terms.

    Adding the burden of capturing structured data at point of care can’t make things “easier”. It might make things better. Who knows.

    One explanation is that HIT approached this issue with typical software patterns. They think point-of-care is like point-of-sale (POS, no pun intended) so they gave you a GUI, some templates, and some clicks.

    The obvious difference is that the patient could say or show any combination of about a jillion different data points at the point-of-care.

    There are only 17 different toppings for the pizza parlor point-of- sale system. Also, if someone hacks my pizza record, no one risks going to jail. 🙂

  • Mike,

    “most physicians wont seriously consider our solution because we have
    only been in business four successful years.”

    I had the RECs tell me flat out they loved my better mousetrap but would/could not recommend a new system. The RECs wanted a monster company balance sheet, and 1000’s of installed users.

    In addition, they reminded me they did not have the bandwidth to learn and support more than a handful of systems, preferably 1 or 2.

    Of course, I asked “why didn’t you just say so to begin with?”.

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