When healthcare pundits talk about MACRA they often offer a basic analysis of how the move to value-based reimbursement will be a good thing for healthcare, since then we are only spending money on care that provides value. Many doctors disagree and suggest that value-based reimbursement won’t create the value it purports to create. Either of these analyses overlook many of the benefits that MACRA and the move to EHR software offer healthcare. The reality is that many of the most exciting initiatives in healthcare would not be happening today and would not even be possible if it weren’t for programs like MACRA and the implementation of EHR software. Let’s take a look at some of these improvements.
A simple example is the widespread use of e-prescribing in healthcare. It is hard to imagine how many lives have been saved thanks to the millions of prescriptions that are sent electronically every day in a perfectly legible format. Unfortunately, there is not a good way to count how many prescriptions were read incorrectly or how many hours were spent trying to verify the right prescription because of illegible handwriting on prescriptions. However, we know in the new world of widely adopted ePrescribing, those issues are no longer a problem. Plus, all of these electronic prescriptions provide an actual source of prescribed medications which was impossible to do in the paper world.
Providers sent 1.41 billion e-prescriptions in 2015, serving 240 million patients. That’s a 300%+ increase since 2010.
When you look at the new opportunities available for personalized treatment, almost all of them are made available thanks to our move to EHRs. Certainly, some basic clinical decision support (CDS) was available to doctors as early as an app on a Palm Pilot (and likely even earlier). However, those were much closer to electronic reference materials than they were to true personalized medicine based on a patient’s unique health data that could provide high quality clinical decision support at the point of care.
I recently heard of one doctor who kept a screenshot of every clinical decision support or medication alert he received that helped save or improve the life of his patient. This was a great reminder of why technology could be a great asset to providers and their patients. Plus, technology is just getting started at leveraging a patient’s data to provide a more personalized patient experience. These personalized medicine initiatives are built on the back of the movement started by EHRs and quality reporting programs like MACRA.
(For more on this, check out my webinar: Understanding Patients: The Secret to A Thriving 21st Century Medical Practice.)
The Road to Interoperability
While we all know that government programs to date have failed at providing true health data interoperability, we weren’t even talking about widespread sharing of health data in the paper world. Faxing individual medical records was acceptable when it came to data sharing because it was irresponsible and impossible to require that a provider organization share all its paper medical records in real time with whatever provider might need them as the patient passed through the healthcare system. While it is frustrating that interoperability is still not a reality in healthcare, at least now it is possible. Prior to MACRA and EHRs we didn’t even discuss the possibility because it was farfetched to even consider it.
Privacy and Security
Thanks to MACRA’s simple HIPAA risk assessment requirement (and meaningful use before it), many organizations have taken a huge step forward in their privacy and security efforts. We all know that risk assessments can still improve, but the MACRA requirement have woken up many of us in healthcare when it comes to privacy and security. The work of security and privacy is never done, but organizations are more aware today of risks than they were even 5-10 years ago. This is in large part thanks to the HIPAA risk assessment requirement
As you look through this list of ways MACRA and EHR software has helped to improve patient care and healthcare in general, it is easy to highlight how we still have a lot of work to do. For instance, e-Prescribing can have errors. CDS isn’t perfect. Health data interoperability isn’t a reality. Security and privacy are still a challenge. While each of these is not perfect, we shouldn’t let the search for perfection inhibit us from acknowledging progress.
In each of these areas, healthcare has made huge progress and many patients have benefited. Remember that these new efforts don’t need to be perfect. They just need to be better than what it replaces. EHR is better than its replacement in a wide variety of ways that has improved patient care today, and will form the basis for improved patient care in the future.
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