Last month, in a post entitled, “Putting the Cart Before the Horse”, I talked about the inter-relationship between the two tasks before the HIT committees—defining “meaningful use” and setting the standards for certification of EHRs under the Economic Stimulus Plan. I maintained that it makes no sense to set standards before there is an understanding of the end goal—exactly what should comprise “meaningful use”. While, to some extent, the work along these two tracks is proceeding in parallel, there is growing recognition that “meaningful use” must be the driver of the EHR standards. Recently, even CCHIT seems to have come around to this point of view.
First, CCHIT backed off of its former all-or-nothing stance on EMR certification, proposing three alternative paths, two of which are “meaningful use” driven. Of the three, (aptly identified as “C M S”!), only EHR-C, Certified EHR Comprehensive, would remain subject to the traditional CCHIT criteria, generally accepted to be “overkill” as far as “meaningful use” is concerned. EHR-M, Certified EHR Module, would allow providers to assemble technologies from varied certified sources, as long as the resulting system enabled the users to meet the (yet to be set) Federal “meaningful use” requirements. EHR-S, Certified EHR Site, would allow providers to build an EHR from non-certified sources, as long as those providers could accomplish “meaningful use.” Although this is just a proposal, which hasn’t even been formally entertained by the HIT Standards Committee yet, it represents a major concession by CCHIT and a significant step in the right direction.
Certification will mean very little, however, if the “meaningful use” bar is set at a level deemed unattainable by physicians. Here too, CCHIT has recently come to recognize the realities of the EHR marketplace that have limited adoption to-date. Acknowledging the inherent challenges facing physicians, CCHIT recommended to the Office of the National Coordinator for Health IT (ONC) that “meaningful use” be simplified so that a greater number of physicians will achieve successful participation in the ARRA incentive program. Shifting the focus from features to physician use and noting the need to tailor “meaningful use” measures so that they are also relevant for specialists are both critical to encouraging adoption.
The pressure must be kept on the decision-makers in Washington to ensure that the burden placed on physicians is not disproportionate to the benefits to be achieved. There is still time to make sure that the “voice of the physician” is heard. You can make your voice heard by clicking below to read and then sign our petition, as hundreds of other physicians and administrators have already done.
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Evan, thank you so much for following this important issue for all of us. I’ve read each of your posts on this rapidly unfolding topic and have found few other sources as editorially in agreement with our practice’s philosophy.
We do not treat “populations” and do not perform clinical studies. We treat patients one at a time, we read and appreciate the diligent work provided by medical researchers to determine “most effective treatments” and cannot imagine every physician in the country becoming his or her own “researcher” just because they “have the data.”
The inherent suggestion that every doctor in the country will begin to somehow to conduct research based on his practice’s limited outcomes experience is only surpassed by the fallacy that insurance carriers will be able to amalgamate this data into meangingful clinical protocols for their enrollees.
The irony is that the academic physicians have not seen this as a greater threat to their role in researching and developing treatment protocols. Perhaps they are less concerned about where to data originates and more interested in the epidemiological significance i.e. more patients = more data = more significance, despite the fact that most of the “controls” and even validity may well be totally lacking from this “more data”.