At first glance at an optical illusion, a distinct picture is clear. However, after taking a few moments to adjust eye depth and perception, other perspectives emerge. Following a distinct moment of change, the viewer is able to understand and appreciate the significance of the artwork on an entirely new level.

  meaningful use ehr requirements optical illusion example Meaningful Use and HITECH are by no means “illusions” and, in fact, provide an extensive listing and explanation of requirements. Nonetheless, the act of studying Meaningful Use does share a few similarities to the act of studying an optical illusion. It will take you a few minutes (and likely more) to understand what is being said, and a few more to understand the true implications.

While studying an optical illusion, if you only accept the initial perspective, you will miss out on the entirety of the picture. Therefore, when studying the Meaningful Use requirements, it is important to understand the entirety of the Act by recognizing different perspectives.

The following are two perspectives on the feasibility of EHR implementation as outlined under the Meaningful Use requirements: 

View 1:  EHR implementation is NOT feasible 

There is no dearth of articles, resources or opinions regarding the impending Stage 1 requirements for Meaningful Use.  Unfortunately, there is a lack of feasibility.  The intent and purported impact of EMR/EHR adoption sounds great in theory. In practice, however, there are two barriers that may prove insurmountable to the well-intentioned requirements.
As of August 2010, there are no EHRs on the market that satisfy the criteria for certification.  As stated in an article entitled, EMR bonus program poses tight deadline for physicians by Chris Silva of American Medical News:
"There is no EMR system on the market now that offers the capabilities needed for physicians to become meaningful users. Federal officials expect such systems to become available this fall, which would give practices only a few months to install and test the technology before the Jan. 1, 2011, start date of the incentive program. Physicians who already have invested in EMRs now must upgrade their systems to meet certification criteria."
Implementing any new system within a healthcare facility takes considerable time, for good reason. Hospital IT staff cannot be cavalier in implementing systems that impact the delivery of patient care. Careful, methodical testing must be done to ensure no interruption of service will occur.  Racing towards an arbitrary date to demonstrate that X% of orders are completed electronically in order to receive incentive money may be a legitimate "carrot", but if it is the patient who gets the "stick", is that a risk worth taking?
If as stated above, that 'expected' certified systems will be available in the Fall of 2010, what measures will be put on the back burner to expedite EMR/EHR adoption? The criteria have been watered down once already. If meaningful adoption of these regulations is really the goal, the criteria will need significant modifications and, over the three stages, interest and real implementations will fade.
If a small number of providers achieve Stage 1, then achieving significant Meaningful Use will be at risk.
Ferdinand Velasco, MD, CMIO at Texas Health Resources pointed out in a CMIO article, CMIOs give Meaningful Use mixed reviews that,
"If only a minority of hospitals achieve Meaningful Use based on Stage 1 criteria in 2011, the federal government will end up basing its Stage 2 definition next year on limited data."  If that happens, monetary incentives will still provide motivation, but will the original intent and goals of Meaningful Use be recognizable?”

View 2:  EHR implementation IS feasible

For those hospitals that strategically plan to achieve the requirements of the inaugural state of Meaningful Use, this is an exciting step in the right direction. Currently, there are no EHR products on the market that are certified; however, the certifying bodies have been named, and they are planning accordingly to begin work as soon as possible. The process for certifying EHRs and encouraging technological interoperability in hospitals has been given a significant amount of thought and discussion by healthcare leaders and government officials.
Time is a factor in the implementation of EHRs, but the process is realistic. These are major changes to the industry, and like any major social change, naturally it will take some adjustment. The time that will be required to implement the EHR technology will undoubtedly be significant, and those hospitals hoping to meet the Stage 1 of Meaningful Use requirements will need to make the EHR implementation process a top priority.
The hospitals that will ultimately qualify for Meaningful Use will likely be those that have been planning for some time now. It is still possible for a hospital to change its current method of workflow, if they are just now considering the change and hoping to meet Stage 1 requirements. It is important for hospitals to keep in mind that penalties will begin in a few years, and it is best to begin the process sooner than later to meet the requirements. Different project methodologies exist to facilitate timely and effective implementation of health IT initiatives.
For some physicians, one major concern is that EHR adoption will not generate a significant return on investment. A recent article featured in The CT Mirror discussed the reasoning behind some physicians’ resistance to electronic record-keeping, and attributed much of the physicians’ hesitation to skepticism on financial benefit and the reality of Medicare and Medicaid reimbursements.
There is an equally vocal group of physicians advocating that the benefits from EHR adoption are so great that we cannot anticipate the true ROI just yet. As suggested in The CT Mirror article, monetary government savings estimates ranged from $80 billion dollars to as much as $100 billion a year. Without much consultation, one could conclude that amount significant.
Economic stimulus is only one factor influencing the ROI predictions. A number of benefits are found merely improving patient care and the health care industry as a whole. "[EHR adoption] is an absolutely essential ingredient to making the health care system work better," said Dr. Ashish Jha, an associate professor of public health at Harvard. (The CT Mirror, September 2010). “Prescriptions transmitted electronically don't carry the risk of a pharmacist misreading a doctor's handwriting, and some electronic records systems can check for possible negative drug interactions with other medications a patient takes.”
The ultimate goal of the EHR movement should fundamentally improve the United States healthcare system. That is the bottom line, and should be the focus of every physician and healthcare organization. The investments made into improving the interoperability of the healthcare industry are investments made in the future of America.
For more information and points of view on EHR usability, please reference these additional articles:
HIMSS Resources: EHR Usability
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