Meaningful Use: Hype and Misinformation Still Abound

In the wake of the release of the CMS Proposed Rule regarding “meaningful use,” one would expect that the mist would begin to clear and facts emerge. But it seems that as the hype intensifies, so does the dissemination of misinformation.

A consensus among physicians is growing. They rightly feel that the government’s expectations are overly complex, burdensome, confusing, arduous, etc., and that the adoption of a traditional EMR is fraught with peril. The following are two of the comments I received on last week’s EMR Straight Talk:

“I have been ‘paperless’ for 6 years. For most of that time when I have complained about the cost and the increased physician time I have been ridiculed even at the AMA level. The expense is astronomical and there is no way to recoup the cost. I have been in private practice for 35 years and EMR is the biggest mistake of my career. It is somewhat comforting to know that others are evolving to my way of thinking on EMR. I feel this is the brainchild of the IT industry with little or no input from those actually using the systems. Thanks.” —Lee Schoeffler M.D.

“There is another huge ‘cost’, which is the creation and then electronic perpetuation, ad infinitum, of incorrect medical information. I have yet to find a patient encounter spit out by an EHR in which I could easily understand what was wrong with the patient. The automatically generated reports are often in a new language, ‘digmedgib’, for digital medical gibberish. I have read reports from ‘excellent’ EHR systems (one of which is utilized by one of your sources quoted [in another of last weeks comments] which contain disastrous errors created by a 0.5 mm slip of the mouse pointer and a click. This is what happens when two opposite diagnoses differ by one consonant and are adjacent in the pull-down list. We are trying to treat the patient but we are really doctoring the EHR.” —Sandra Brown, M.D.

David Brailer, M.D., former “Health IT Czar,” whom I quoted last week regarding the likelihood that penalties for non-participation will be dropped, also forecasted that “we’ll be approaching the peak of the hype cycle” before a “real slide back to reality,” with CMS money coming “slower than everybody thinks.” Like me, he recognizes the challenges the legislation presents for physicians.

In light of the 556 pages of publicly available, detailed information about the “meaningful use” legislation, I find shocking the amount and level of misinformation being perpetuated by even the most reputable—or so one would expect—sources of healthcare information. I was appalled by the following ad that the Cleveland Clinic ran in the New York Times recently:

The fact is: EHRs are not required—not now and not in 2014! The legislation explicitly states (in section 3006 (a) (1)) that participation is VOLUNTARY. Shame on the Cleveland Clinic for such a flagrantly irresponsible ad!

Less unexpected is the perpetuation of other myths by vendors of traditional EHRs—those with the most to gain financially from the legislation—concerning the alleged ease with which their products will facilitate the achievement of “meaningful use.” The well-respected EMR blog, HISTalk, recently invited CEOs of EMR companies to address 6 questions related to “meaningful use”, and is currently running a series containing their answers. You can read Part 1, Part 2, Part 3, Part 4, and Part 5 of the series so far, and it will probably come as little surprise to you that my responses are strikingly different than those of the other 9 CEOs! But my opinions do not appear to be in the minority when it comes to how physicians view the legislation, as you can see by the following comments HISTalk received:

“Could not agree more, except perhaps to extend the ‘extremely burdensome’ costs considered as not only financial, but also temporal and operational. In our little office, the greatest bane is workflow adjustment. There are just so many hours in a day and, functionally, our primary focus during most of them is to care for patients, not figure out how to enter data, collect stats, tweak templates, and distribute meaningfully to the cloud.”

“Frankly I am surprised that a couple of these guys (namely Girish and Pead) seem to believe that the 80% CPOE adoption will be so easy. Either they have incredible confidence in their software and the ability of their staff to affect change management, or, they are incredibly out of touch with the culture of your average physician practice. Steele is correct is suggesting it will be a huge challenge and Skelton understands that the transition will be more difficult for private practices and specialists in general.”

And just yesterday on HISTalk Practice, Dr. Gregg Alexander, a self-proclaimed “grunt-in-the-trenches pediatrician and geek” agreed:

“It feels as if the voices which ring most true to my trench-weary ears are not the ones being heard most loudly nor echoed most frequently. Most of the big brains of the industry, be they governmental guiders or corporate cognoscenti, seem to be enraptured with the power and the glory of the Meaningful Use Criteria [MUC]. . .The majority of healthcare in the U.S. is provided by smaller players who have no I.T. team, who have techno-illiterati-filled staffs, and who really want to focus on doing what’s right for our patients, not our data centers.”

Your voice counts. On Tuesday, the voters in Massachusetts made their feelings known, and we will see the impact shortly. Keep speaking out, and I will too.

Related posts:

1. The Meaningful Use Folly
2. Readers Respond: The Exorbitant Cost of Meaningful Use
3. The EMR Equation: Break-even Point for Meaningful Use
4. AMA Aims to Deter Purchasing of Failure-Prone EMRs
5. Stage 2 Meaningful Use: Specialists Still Left Out