HIT Policy Committee Focuses on Physicians

HIT Policy Committee Focuses on Physicians
A very positive conversation took place at yesterday’s HIT Policy Committee meeting, and it put the focus squarely on the physicians—a focus that in the past seems to have gotten lost in the shuffle.

The Committee was reviewing and finalizing its comments for submission to CMS on the Proposed Rule for Stage 2. A healthy debate ensued regarding who should have to enter the orders into the EHR to satisfy the CPOE requirements—the physician or a designated clinical staff member. In response to a suggestion that there were reasons for requiring the physician to personally enter the orders into the system, Neil Calman, MD, raised the discussion to another level by asking about the entire purpose of EHRs and meaningful use. Dr. Calman challenged his fellow committee members to think about how an EHR should be expected to change the way physicians practice—and how it should not. He asked why we would want to bog physicians down with tasks that other staff were already doing instead of helping physicians focus on the work that utilizes their highest skills and expertise.

The EHR incentives are definitely encouraging EHR adoption, but we should not lose sight of why increased adoption is such an important goal. The value of an EHR to a physician is not the $44,000 incentives—it is the potential for increased productivity and efficiency, better and safer patient care, and the ability to share information. It’s easy to get caught up in creating comprehensive measures that ensure that the interests of all stakeholders are met, and in doing so, to lose sight of the practical impact on physicians’ workflow. In the case of yesterday’s CPOE debate, the committee came up with a recommendation that preserves the intention of the CPOE measure—and meaningful use in general—while respecting the value of the physicians’ time. I hope this conversation will set the tone for future meaningful use deliberations.

6 thoughts on “HIT Policy Committee Focuses on Physicians

  1. Physicians are very busy and pressed by time to see patients. To add the tasks of them entering orders to the CPOE is not going to increase their productivity. Currently, nurses obtain drs. orders manually and trust their staff to follow through with the order. A trusted and well trained employee can enter drs. orders to the CPOE. Physican productivity in the short run, or even in the long run, may not be increased. If the physician were to become more productive entering orders to the CPOE, then they will have to deal with the transition from ICD-9 to ICD-10, which will definitely impact and reduce their productivity and delay reimbursement as well. With ICD-10, their entire staff’s productivity will reduced. So, why do we hear all this talk about the increase in productivity, better quality patient care, when the physician is already heavily burdened with documentation hoops.

    I took my mother today for a minor surgery procedure and the amount of time that the nursing staff spent on entering and answering Medicare questions took longer than the procedure itself. In fact, there were two RN’s working on her at the same time. One was preparing her for the procedure, while the other one completed or answered all the questions on the EMR system. Just think, we are only in Stage 1 and entering Stage 2. It’s the back end of Meaningful Use that I am concerned with. Physician liability for business partners that leak or breach PHI and subsequent fines or penalties. What if a patient leaks their PHI, are physicians liable for that too and be exposed to fines?

    My overall question is that beyond that savings, increased physician productivity, and improved patient care, are we being setup to fail so the next step is socialized medicine? Personally, I think that is the path we are on, think about it.

  2. My God…is that a shred of common sense I just heard? EHR’s are systematically “dumbing down” medical documentation into a homogenous sea of largely useless, mind-numbing boiler-plate. Specialists hate these new notes, worry that they will miss important information wading through page after page of irrelevant information about the patient’s diet and smoking history. This alter of interoperability CMS worships at is simply assumed to make patient care better without any actual evidence to support it. They live on another planet relative to the real practice lives and pressures of physicians.

    Physicians want to work for patients and then for their success and the success of loyal staff who work for them. Once they wake up that CMS and HIT want to control every aspect of their documentation process and turn them into drones slaving a to serve the false god of big data, they will reject Meaningful Use en-mass.

  3. Chris, I appreciate your comments and I agree that CMS and HIT are living in the real practical healthcare environment.

    I advise all small physician practices, whether they have an EMR system or not, that NOW is the time to streamline their office procedures and financial operations. They need to look for ways to reduce costs/expenses in their accounts payables, get after the outstanding AR (that is money that is already earned and deserved), look at the number of staff by conducting job audits/evaluations, establishing a labor cost montoring system that is based on patient volume, establish work standards, look for ways to improve staff productivity immediately, and open a cash reserve account that money is deposited monthly for the short-fall that is coming with the advent and transition to ICD-10. Also, any savings now can be used to purchase an EMR system or upgrade a current system to meet the MU requirements. There are “gold nuggets” savings to be discovered in every physician practice.

  4. Chris, I meant to say that CMS and HIT ARE NOT living in the real healthcare environment, sorry.

  5. The basic thought behind EHR has been health, welfare, and safety of patients we love and with it quality, cost, and fairness. One can minimize the problems if we focus on who does what and provide them an avenue to do it.

    For example, the specialist honestly although cares about smoking, vaccinations, and medications which our patients take–many from consumer stores etc. should focus on hand, elbow, shoulder, hip, knee, back, diabetes, cardiac, urology, etc. and there are so many subdivisions.

    General practitioners, PCPs, internists, and pedi-folks ought to be paid double the incentives to specialists as they work hard and more for them but most important is why have committee members who do not see patients and are paper pushers. Obama admin should pay them first before even getting into meaningful use 1 or 2 as they are doing stimulus plans for car, solar, banks.

    Why health care providers this way? I think EHR is wonderful tool taking care of patients and improve quality and reduce cost but hopefully paper pushers know that it is at the cost of health care providers as we see.

    Best wishes,

    Dinesh

  6. We have had EMR in our office for over seven years and at no point has it made us more efficient. In fact, it slows us down as information has to be maually input from the referral sources. As of yet, we know of no interactivity that permits easy exchange of information between systems. Our hospital switched to a complete EHR 3 years ago and we have had an increase in errors. There is no scientific study that I am aware of that proves that an EMR increases productivity, efficiency or safety. It seems that policy is made without actually a trial to see how these changes impact practice and patient throughput. I am heartened to see someone speak up. In our hospital we call the computer generated notes that have every lab, vital sign and detail from every visit “Note Bloat”. They are difficult to read and even more difficult to glean any useful information from the voluminous charts and graphs, etc. It is fallacious to think that the $44,000 will even come close to compensating for the cost of computer hardware, software and the ubiquitous and expensive service contracts that go on forever.

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