When the news hit that that the over 80 percent of hospitals have yet to achieve the requirements for the first stage of meaningful use, the blogosphere erupted. However, what garnered more attention is what came next when the American Hospital Association (AHA) asked for a change in the regulations. Before I get into this issue, let me remind our readers about meaningful use and why this is important in healthcare and healthcare reform.
First, meaningful use is a $14.6 billion dollar U.S. program that aims to encourage and offer financial incentives to physicians to adopt electronic medical records. With more recognition that electronic health records can benefit the delivery of healthcare (e.g. decrease medical errors, increase patient safety), there has been a push by the federal government for practices and systems to adopt electronic medical records. I mean after all, how legible are providers handwriting anyway? 
So what happened next?
Well, let’s go back to meaningful use and stage one for a second. From a passionate post on e-patients.net outlining the issue:
“The issue at hand: current regulations for Meaningful Use Stage 1 (already in force) require that we be given our records within four days, but now the AHA says that’s impossible (‘not feasible,’ in their words) and they want thirty days. A month.”
e-patient Dave makes a very compelling case as to why these requests fly in the face of patient empowerment. Rather than continue this line of reasoning that I tend to agree with, I want to point out some of the underlying reasons we see issues like this arise. Please note, I am not in any way making excuses for the decisions made by the AHA, but rather pointing out why we see requests like this being made.
First, change in healthcare is hard. In our post yesterday on this website, I discussed the idea of a primary care cooperative extension service. Much of the rationale behind such an effort is that together we can help each other learn ways to improve or change healthcare. When we think of the complexity in healthcare it can quickly be overwhelming at how many levels change needs to occur simultaneously to see true change in the larger system. Simply adopting a medical record is not as easy as it sounds, and everyone from small primary care practices to large hospital systems are demonstrating this daily.
Second, we have competing business models and competing business interests that often do not encourage us to collaborate and integrate. You may ask what this has to do with medical records, and the answer honestly is everything. Consider how very few medical records and healthcare systems have “interoperability.” Read Bill Gardner’s post on this topic to see a real life example of this problem. For better of for worse, the market is saturated with multiple electronic medical records that have little ability to connect to other electronic medical records.
Third, we are really talking about a cultural shift in healthcare. Call it a move from Health 1.0 to Health 2.0; call it a new paradigm. Either way you look at all the changes in healthcare, including the adoption of electronic medical records, it is a major cultural change. And what we know about culture change is that it never happens as quickly as we want; after all, primary care and healthcare in general makes more sense when you see it as a complex adaptive system.
So should we be outraged at the inability for some to move as quickly as we would like? Absolutely.
Should we speak out and tell others of our outrage? Absolutely.
Should we be surprised that yet again it is the community who will not be helped by these delays? Absolutely not.
Should we be surprised by any of this? Absolutely not.
When ones studies patterns in healthcare certain consistencies can be seen. The biggest consistency seen and demonstrated in the example above by AHA and meaningful use is that changing practice is hard.
But really, when has a challenge ever stopped us before?
Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.
