Looking beyond digital health records to the next horizon in healthcare innovation

Filling out a medical history questionnaire shouldn't feel like writing a memoir. Nor should your doctor have to guess your relevant medical history from a lay description of something that happened a decade ago in another state. Is my rhinoplasty from five years ago relevant information for my new primary care provider? What about the history of heart disease on my mother's side or my father's? Questions like this make me grateful for the increasing digitization and portability of medical records. But questions remain. For all of the progress we’ve made, has healthcare become more efficient? Have we improved the experience for providers and patients — or have we merely created digitized versions of healthcare’s inherent pain points?

We have Congress to thank for the digitization of medical information (really!). Today’s modernization of health records and systems is a reflection of the spirit of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the Meaningful Use program it created, the goal of which was to digitize the nation's medical records and innovate healthcare for the 21st century. The widespread use of COVID-19 vaccine data and digital proof of vaccine requirements is but one example of a broader acceptance and push toward ease of access to one's personal health information and translation across platforms. Yet — 13 years and one pandemic later — health IT is still wrestling with what it means for health data to be portable and accessible while maintaining agency and privacy.

The value of the adoption and growth of digital health records cannot be underestimated. But the path toward progress has been bumpy. As the pace of technological innovation increases exponentially, it’s important to reflect on what the Meaningful Use program taught us about approaches to create a better healthcare ecosystem.

Approaches based on flexibility — not rigidity — are essential

The HITECH Act intended to radically accelerate the digitization of health information and adoption of electronic health records systems through a mix of financial incentives and backloaded penalties under the guise of improving efficiency. On its surface, giving clinicians and patients immediate access to health information across institutions and platforms should create a more efficient health information landscape.

Although policymakers’ visions about the benefits of technology were correct, they failed to appreciate the foundational environment in which innovation flourishes: one that is organic, enthusiastic, and encourages voluntary adoption. Innovation driven by regulation can be rigid and assumes that everyone does everything the same way. But medicine is not the production of widgets, and the same principles of efficiency do not apply. People will adopt technology that makes life easier. But not everyone has the same concept of what’s efficient. Meaningful Use ignores the fact that vast differences between the desires and needs of clinicians and their patients exist. The program incorrectly assumes that medical care is mass-produced uniformly by all providers, and all that patients desire the same engagement with their clinician. The introduction of new health IT platforms presents an opportunity to engage clinicians in ways that will encourage adoption and buy-in.

Focus on outcomes, not box-checking

Meaningful Use intended to improve efficiency in healthcare data delivery — but what it did was further burden providers and health IT developers with "check-the-box" regulatory requirements. Rather than focusing on outcomes, clinicians encountered greater burden in documentation, chart review and computerized provider order entry requirements. A recent study in the Annals of Internal Medicine found that physicians spend just more than 16 minutes on electronic health records per patient, an average of one minute and 14 seconds longer than a typical fifteen-minute appointment slot. On the health IT developer side, resources are spent building and maintaining compliance with program regulations rather than developing features that clinicians feel are meaningful to their ability to provide care. This program has forced providers to spend more time clicking boxes created to meet requirements that only federal regulators find meaningful. The next iteration of healthcare technology needs to focus on outcomes, not administrative box-checking.

Experiential interoperability is worth striving for

Interoperability was one of the core tenants of Meaningful Use. So much so that in 2019, The Center for Medicare and Medicaid (CMS) changed the program name from Meaningful Use to Promoting Interoperability to reflect its ongoing commitment to connectivity, patient data access, and system-wide health information exchange. But ask anyone who sits in front of an EHR and they will tell you that there is still much progress to be made. Today’s landscape disincentivizes full experiential interoperability, promotes siloed health data, and emphasizes regulatory compliance over innovative advancement in data exchange. The last decade has brought dramatic IT improvements in the way we do our banking, apply for mortgages, or even purchase a vehicle. These same principles of safe, seamless data transfer, consumer protection, and user experience need to apply to the exchange of personal health data and EHR interoperability to enable real progress.

You have to learn to walk before you can run

Meaningful Use prepared providers for the ongoing changes to reimbursement programs as the industry transitions from fee for service to value-based care. It allows providers to identify opportunities for improvement in clinical quality, track and monitor performance across conditions, and encourage patients to be proactive in their care. For example, the electronic prescribing objective can reduce costs by helping clinicians choose cost-effective medications, while patient electronic access goals allow patients to manage and make decisions about their care. While many of Meaningful Use's intentions were aspirational – and unrealized — there has been slow but sure progress when it comes to influencing the adaptation of behaviors and attitudes towards quality-driven models. That’s an undeniably valuable step in the right direction.

What’s next?

In 2015, the American Medical Association called on Congress to "refocus the Meaningful Use program on the goal of achieving a truly interoperable system of EHRs that will support, rather than hinder, the delivery of high-quality care." The last seven years have brought the introduction of the 21st Century Cures Act, along with Information Blocking rules and a framework to establish a universal floor of interoperability nationwide. The goals of these were to realize HITECH’s original vision of digitizing the health information landscape. As we look toward 2023 — and far beyond — regulators must be encouraged to apply the lessons learned from Meaningful Use to focus on outcomes, support stronger partnerships between technologists and clinicians, and allow innovation to flourish.