It’s time to look closely at “meaningful use.” In past posts, I have argued that “meaningful use” must be the driver of the EHR standards and certification process, and it appears that the HIT Policy Committee has come to the same conclusion. At its July 16th meeting, the Committee shifted its emphasis from the features and functions of the technology to the facilitation of meaningful use. CCHIT’s wings were clipped—its long list of certification criteria will be cut down to only those that directly correlate with meaningful use, and the role of the organization itself was narrowed. It will be only one of the bodies charged with certifying EHRs. The implication for physicians is that they should stop focusing on certification requirements and turn their attention to a realistic evaluation of their ability—and their desire—to demonstrate “meaningful use.”
The questions for physicians to analyze are: “Will I actually be able to meet all the requirements?” “Do I want to take the time and effort to do what is required?” and “Will the benefits outweigh the costs to my practice?” I have poured over the revised (and allegedly simplified) “Meaningful Use Matrix” that the Policy Committee adopted in principle at its July meeting. While the goals are laudable, the demands on physicians are onerous. I can only venture a guess as to where some of the ideas came from, but I can say for sure whose interests have still not been taken into account—the physicians’.
Below is a list of just some of the requirements for 2011 and 2012—the easiest years to qualify for incentives (i.e., the years with the least stringent set of objectives and measures). You can review this list and make your own determination. I’d just like to open with three of my “favorites” to start you off on your analysis:
- Use of CPOE (Computerized Physician Order Entry) for all orders including medication, laboratory, procedure, diagnostic imaging, immunization, and referrals
- As Rosemarie Nelson said in last week’s Straight Talk interview, CPOE is a non-starter for most physicians. This type of data entry by physicians places a tremendous burden on their schedules and drastically affects their productivity. MGMA has expressed the same concern in a July 23rd letter to David Blumenthal.
- Provide electronic syndromic surveillance data to public health agencies
- To be honest, I don’t even know exactly what this means or how it is done, but I know it’s not something the typical physician is likely to want to add to his/her routine!
- Document a progress note for each encounter [ostensibly via point-and-click data entry]
- The point-and-click debate is an old one, and the verdict is in. For the vast majority of physicians, it is just too slow; and it has a negative effect on the quality of exam notes.
Here are some of the other objectives and measures. I encourage you to read the full, exhaustive set of requirements on the Meaningful Use Matrix:
- Maintain an up-to date problem list of current and active diagnoses
- Record demographics including preferred language, race and ethnicity
- Record advance directives
- Record vital signs
- Record smoking status
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach
- Report ambulatory quality measures to CMS
- Implement one clinical decision rule
- Upon request, provide patients with electronic copy of health information including lab results, problem lists, medication lists and allergies
- Provide patients with timely electronic access to their health information including labs, problem lists, medication lists and allergies
- Provide clinical summaries for patients for each encounter
- Report quality measures to CMS
- Report percent of all medications, entered into EMR as generic, when generic options exist in the relevant drug class
- Report percent of orders for high-cost imaging services with specific structured indications recorded
- Report percent of all patients with access to personal health information electronically
- Report percent of all patients with access to patient-specific educational resources
- Report percent of encounters for which clinical summaries were provided
- Report percent of encounters where med reconciliation was performed
- Report percent of transitions in care for which a summary of care record is shared (e.g., electronic, paper, eFax)
- Stratify reports by gender, insurance type, primary language, race ethnicity
I truly hope that the voice of the physicians will ultimately be heard and that the final meaningful use requirements will be realistic and attainable.
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