The Primary Reason for the Push for EHRs

There is a lot of confusion about the meaningful use incentives. The most significant relates to the government's objectives in offering them. Understanding that I was not in the room when the plan was concocted, here's my take: It is all about data and transforming that data into information, knowledge and, eventually, wisdom. Any impact on physician productivity and job satisfaction is beside the point.

Each treatment facility captures and stores vast amounts of data relating to patients, treatments, and outcomes. The great thing about data is that it is always accurate, absent errors in recording or transcription. The problem with data is that it has very little value out of context. That is, my blood pressure readings alone say a limited amount about my general health.

The government's first goal for the EHRs is to gather relevant data over time and make it available to algorithms that turn it into information and guide/support/suggest physician decisions regarding a patient's treatment. In a perfect world, the algorithm automates the physician's current thought process, and constantly keeps that process current with the best evidence available.

The data must be recorded consistently so the algorithm interprets it properly. Recording the data consistently means knowing (and remembering) whether the algorithm is looking for height in centimeters or inches and weight in kilograms or pounds. It also means "structuring" the responses for non-numeric data. This almost always means a drop-down list of optional responses.

EHRs have two advantages over paper charts as regards data capture: Consistency standards can be imposed and, once entered, the data is available to the algorithm with no further action. None of this says anything about the quality of the algorithm, but the algorithm is useless without its data inputs.

The government's second goal for EHRs is to be able to share patient data across providers and facilities, which requires another level of consistency: consistency in data format and meaning across several entities. One way to refer to this requirement is to say that the entities must use the same data dictionary. The presumed benefits are that each provider has ready access to all patient data; tests are not duplicated; and the stage is set for effective provider collaboration.

The government's third goal is to mine all of this data to create knowledge by detecting trends, identifying best practices, and confirming or refuting theories.

The Holy Grail is to use this knowledge to inform the development of both treatment and payment algorithms. This step takes the data through information to knowledge and, some would say, all the way to wisdom.

While these goals are laudable, two important questions remain unanswered:
• Are any or all of these goals achievable?
• Assuming they are, can the benefits outweigh the costs?

It will be quite awhile before we have definitive answers. It does help, however, to identify the government's primary driver in the push for EHRs.