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Meaningful Use (MU) is coming under more scrutiny these days. Partly because the program soon will be heading into its third and final phase, everyone is interested in MU’s progress and its impacts. Despite MU’s success in creating a tipping point in the adoption of electronic health records (EHRs), usage attestations suggest that providers are not sticking with the program as vendors have been slow to certify their products for the stage 2 requirements. While a slowdown in meaningful use uptake is not the optimal outcome as far as the government is concerned, MU does create opportunities for pharmaceutical companies to improve quality and outcomes.
Today’s MU landscape. Meaningful use is a federal incentive program created to foster adoption and use of health information technology (healthIT) such as EHRs, including those with electronic prescribing functionality. Use of EHRs is expected to improve quality and outcomes while at the same time reducing costs of care.
According to the government, MU exceeded its goal of half of physician offices and 80 percent of eligible hospitals having EHRs by the end of 2013. Despite this early success, participation seems to be dropping off as we are entering stage 2 of the program. One indicator is physician attestations. MU attestation is a process that documents whether an organization or individual is ‘meaningfully using’ certified EHRs by successfully fulfilling government-mandated requirements. The scope of the requirements has ramped up from MU stage 1 to MU stage 2, which will run through 2016. Successful attesters are eligible for incentive payments. Unsuccessful attesters and non-participants will have their Medicare payments reduced because of noncompliance, beginning in 2015.
So far, the vast majority of attestations have been for stage 1 of the MU program. For stage 1, there has been a substantial drop off in 2nd year attestations. In other words, physicians attested for the first year and then, for various reasons, opted not to continue to attest in subsequent years. A common theme for 2nd year dropouts has been that the real cost of EHR adoption far exceeds the cost of the software acquisition covered by the MU incentives, both in terms of lost productivity and required workflow re-engineering.
MU Stage 2 has now begun. A large number of EHR vendors who certified their systems for stage 1 have not yet done so for stage 2. We can only speculate as to know why this is the case or what these vendors’ intentions are relative to certifying for MU stage 2. While the hundreds of such vendors don’t represent the majority, their products are in the offices of more than 40% of physician EHR adopters. This significant core of physicians then face a tough choice – do they continue using their chosen EHR and drop out of MU or do they switch systems?
MU clearly is facing some bumps in the road, which many find to be quite troubling. MU has been a major investment: the federal government has paid out more than $33 billion in incentives to 383,000 healthcare providers – both individuals and groups – between May 2011 and April 2014 to help them adopt certified health IT. Now that investment is being called into question. In a story reported by Politico, Rep. Michael Burgess (R-Texas), a former obstetrician/gynecologist, was quoted as saying, ‘As we get to the end of those dollars and they’ve been expended, have we gotten what we’ve asked for?’ ‘Probably not exactly,’ he continued. ‘Some of that responsibility lies in the United States Congress for sure.’
Opportunities for pharmaceutical companies. Despite the issues involved with keeping MU up and running, the program unquestionably has fulfilled its intended purpose of furthering adoption of EHRs. Whether physicians participate in MU or not, virtually all of the EHRs they have purchased contain MU-mandated features. The drops in physician attestation rates suggest that such features may not be used at all or to their fullest extent. This creates opportunities for pharmaceutical manufacturers to advantage those features to improve outcomes.
There are several examples of these opportunities. One of the MU measures evaluates the use of the EHR to send reminders to patients for preventative or follow-up care. A Point-of-Care Partners (POCP) analysis of attestation data reveals that only 18% of respondents are using their EHR to send reminders. Encouraging practices to leverage their EHR investment to remind patients of appropriate care, and assisting practices to ensure the use of appropriate care guidelines, is a ready-made role for pharmaceutical manufacturers.
Similarly, 55% of attesters reported providing patient education materials to patients. Supporting practices with current and appropriate patient education materials encourages patient engagement, and promotes medication adherence.
An interesting finding revealed by POCP’s analysis is that 84% of respondents attested positively to the ‘drug formulary check’ measure. It calls for a physician to have ‘enabled the (formulary validation) functionality and have access to at least one drug formulary.’ This means that as long as the EHR has formulary validation ‘turned on,’ the physician can attest that she or he has met the requirement. There is no obligation to look at the formulary data, or to use the data to make clinical decisions. While this is checking the MU box, more can be done.
A relatively high (84%) instance of formulary data availability creates an opportunity for pharmaceutical manufacturers to push for more comprehensive and higher quality formulary data. This will have two effects. First, the formulary data will be used for more than ‘checking a box’ for meaningful use. Secondly – and more importantly – it will help drive formulary compliance. Formularies are a cost of doing business for pharmaceutical manufacturers, so a higher level of formulary compliance provides a return on that investment.
Review of the meaningful use attestation data reinforces the anecdotal evidence that we’ve been seeing in our physician practice and EHR vendor engagements. Practices are slow to adopt new features, even those which are required for meaningful use. As a result, treatment protocols which are in place update very slowly, despite the introduction of new decision support algorithms based upon clinical findings which affect suggested treatment protocols.
We at Point-of-Care Partners believe that an effective way for pharmaceutical manufacturers to harness the power of EHRs is to create programs which prioritize and promote clinical guidelines that impact strategic therapeutic areas. Simplifying the EHR implementation of these guidelines strengthens the partnership with physicians, and yields better outcomes for patients.