The federal government's certification program does not ensure EHR vendors create safe, secure, interoperable or usable systems. The health IT industry focuses on developing EHRs to meet MU and certification requirements, rather than developing technology that supports physician and patient needs. MU Stage 3 continues this tradition without incorporating any lessons learned from Stages 1 & 2.

There have been a few beneficial tools that stemmed from EHRs and MU, like the ability to send electronic prescriptions to pharmacies. However, it takes more than a few tech updates to improve the quality of care in our country.

Many physicians still can't track the longitudinal care of their patients or electronically search for records at local hospitals. Many EHRs don't allow for patient-matching, nor offer provider directories. Exporting and analyzing data from EHRs is cumbersome and sometimes not allowed by the EHR vendor.

Initially, MU's Stage 1 garnered wide support across the health care industry. However, the program has lost support since then for a number of reasons:

• MU's Stage 2 was established under the assumption EHRs were well-designed and could meet demanding requirements, which wasn't the case.
• Many caregivers see MU as a roadblock to innovation because there's a significant lag between federal regulation, EHR system design and national health priorities.
• MU ignores the critical needs of patients who have chronic medical conditions and the differences between medical specialties.
• The focus of EHRs is misplaced; it perpetuates product development heavily influenced by federal requirements, rather than by the high-value needs of patients and physicians.
• Data exchange between EHR systems is difficult and costly. EHR vendors have no business drivers to reduce data exchange costs or to ease the transition from one EHR product to another.
• Federal mandates continue to evolve and push deadlines without taking the time to incorporate lessons learned from the past.

MU participation has decreased since 2013. From 2011 to 2013, about 58,000 physicians actually participated in the MU program for three concurrent years. Between 2013 and 2014 there was a drop in attestation of over 22,000 physicians.  Less than 10 percent of physicians were able to meet MU Stage 2 requirements in 2014. This year, more than 250,000 physicians will receive financial penalties due MU program requirements.

No, but doctors are finding it very difficult to meet MU regulations for many reasons. The max monetary incentive doesn't come close to covering the real costs of purchasing, maintaining, and upgrading their electronic health record systems (EHR); let alone the cost of exchanging data with other hospitals or clinics. Physicians will lose an average of $43,000 over a five-year period if forced to use EHRs, abiding by MU measures, and upending their workflows.

The medical community embraces new technology to help prevent diseases, and diagnose and treat patients. More than 80 percent of physicians have EHRs. Most physicians use tablets, personal and desktop computers and smart phones to streamline their day-to-day work. However, EHRs and the MU regulations make doctors' jobs more complicated than need be, leading to:

• Increased wait time for patients
• Less one-on-one time for patient-physician relationships
• Inconsistency with patient information

Physicians have a proud history of sharing information between themselves and with their patients.  Today’s EHR systems are not interoperable, so patients must access different portals to retrieve records from each different physician they see. Electronic records accessed through patient portals are not presented in easily-digestible formats and are often displayed out of context, confusing patients, their caregivers, and leading to frustration.. Also, the rules around protecting electronic patient info are very complex and physicians tend to err on the side of caution.

It’s still very difficult for doctors to receive medical records electronically. The government dictates how EHRs are developed and does not require that systems have the ability to seamlessly transfer patient data. MU Stage 2 upped the ante requiring physicians to meet information exchange objectives that are either out of their control or not supported by current technology. Stage 3 requirements will only further burden physicians by increasing the program’s complexity and continuing the issues we see in EHRs today. 

EHR design focuses on meeting MU objectives, rather than creating a tool that supports patient care. Therefore, the functionality of EHRs primarily measures MU compliance and meets billing requirements. MU regulations don't prioritize useful tools doctors need, such as matching patients with their records, seamless data exchange, and ensuring the privacy and security of patient information.