Physicians Cry “Uncle” Over Meaningful Use

Physicians Cry 'Uncle' over Meaningful UseThe increasingly unrealistic demands of meaningful use are leading to a groundswell of resistance. While 96,000 physicians have demonstrated meaningful use and earned EHR incentives, the majority did so while complaining about the negative impact that the Stage 1 “minimal” set of requirements had on their practice workflows. (See the results of a physician survey and read physicians’ comments in my last EMR Straight Talk post.) As Stage 2 approaches, those who have previewed the increasingly complex and demanding requirements are consumed by trepidation. Many are already considering abandoning meaningful use after they collect their $30,000 for Stage 1. Despite the fact that no one has yet had experience with the Stage 2 requirements, the Stage 3 proposal from the HIT Policy Committee is already out for public comment. Physicians and the professional organizations that represent them—already close to the breaking point—are crying “Uncle!”

The following is only a partial list of organizations that have commented: the American Medical Association, American Academy of Family Practice, College of Healthcare Information Management Executives, American College of Physicians, and the American Hospital Association. You can read their comments by googling the organization name and “Stage 3 comments” or “Letter to Mostashari.”

Although they phrase it in slightly different ways, all of these organizations are pleading with the powers that be to slow down what is perceived as a runaway train. Their comments center around several problems: lack of EHR usability, unrealistic and excessively complex requirements, the undue speed with which they are being imposed, and a lack of evidence of the program’s success. Physicians see the program as a massive data collection and reporting project with no proven quality improvement outcomes attached to it. Unless the government pays heed to the concerns and recommendations being voiced, the EHR incentive program is doomed to failure. Physicians will simply toss in the towel.

The following is a description of the most common sentiments expressed in the letters and formal comments:

  • Stage 3 should not even be considered until the experience of Stages 1 and 2 can be evaluated to see what was actually accomplished and what the cost is to physicians. Many are calling for an independent assessment of the program. It is not sufficient to merely gloat about how successful the successful meaningful users were—an analysis must be conducted to investigate why other physicians were either not successful or chose not to even attempt to achieve meaningful use.
  • In addition, Stage 3 should not occur until at least 3 years after Stage 2, giving physicians and vendors sufficient time to move forward.
  • EHR usability is identified as a major issue in every set of comments. EHR de-installs are increasing in number as physicians abandon legacy systems. The impact of a lack of usability is compounded when physicians attempt to use an already challenging system to meet an overwhelmingly challenging set of requirements. When workflow is negatively affected, the costs to physicians can quickly exceed the benefits.
  • The AMA suggests that the government conduct user-satisfaction surveys—by practice type, size, and specialty—and incorporate the results into the certification requirements going forward.
  • Meaningful use remains a primary-care program that, despite the addition of a few specialist-focused measures, does not adequately recognize specialists’ unique workflows. They resent being asked to report on measures that have minimal, if any, value to their practices.
  • As the requirements become increasingly complex, it may be time to modify the “all or nothing” approach, and reward physicians for reasonable levels of success. Penalties should be eliminated, or at a minimum, significantly delayed.

Don’t sit back and wait for the Stage 3 rules to be finalized. Express your opinions either by writing to your professional organization or directly to Dr. Farzad Mostashari. It is critical to keep up the pressure on the decision makers.

9 Responses to “Physicians Cry “Uncle” Over Meaningful Use”

  1. Meaningful use is a misnomer. How about meaningful abuse. Unless the EMR can pull some heroics, Stage 2 and beyond look indomitable. I cannot envision my patients accessing their CCD through a portal. I am now a generalist as well as a Neurologist just to keep up with the requirements. Staff time is compromised.

    There are some benefits, but perhaps physicians should determine what is favorable and what is fluff.

  2. Stephen Berman January 25, 2013

    I agree with Douglas Shepard (above). Interestingly, I am also a neurologist.

    Like many physicians, I am anything but a computer phobe. Actually, I love using computers and I fully embraced the idea of EHR’s a long time ago. I’ve done programming and used and programmed numerous computers including mainframes and microcomputers. But the information we are asked to gather is, for the most part, irrelevant to patient care and even for $30K or $42K or whatever, it is hardly worth it. The injection of these meaningless requirements breaks up the natural ergonomics of patient care. Of course, careful planning and a good EHR can help compensate, but I believe that doctors (and I mean “real” practicing doctors in the “trenches”) should have a lot more say as to what constitutes meaningful use.

    I resent being turned into a data collection tool by the government and, perhaps even more so, by the insurance companies. For my practice, and I think this is true of many doctors’ practices, the most “meaningful” information is in the free form narrative that I write, not in the little individual granules of data. Current requirements (including Medicare “bullet points”) over emphasize such easily digitizable data and strive to impose a false uniformity on patient encounters. This comes, in part, from an incomplete and incorrect understanding of certain priniciples of business efficiency which emphasize reduction of variation. But in many specialties, the best understanding of patients comes from highlighting the variation and treating each person individually. When I write a note, I want to be able to recognize each of my migraine patients from the narrative in the note. That’s where the major understanding of the case really lies. True meaningul use, at least in neurology, would be mainly to write a good, complete note which gives a good understanding of the case, a carefully thought out differential diagnosis, and a properly worked out treatment plan.

    Of course, one response can be not to participate in any insurance plans and to develop one’s practice completely independently of such “guaranteed” reimbursements. But this is not practical for everyone. But I am beginning to think that this is preferable to clicking more than a hundred different little boxes every time I see a patient.

  3. “Meaningless use” is a more descriptive name. We have become the most highly educated data entry operators on the planet. In addition, the $18,000 reimbursement for the first year hardly covers the loss of income, increased staff costs and cost of hardware and software for implementation. The “not ready for prime time” imposition of this requirement on physicians has slowed us down and provided less access to care for patients with a silicone based interface replacing a high touch human interaction.
    A shame…really.

  4. Robert Wehner January 25, 2013

    From the begining I have questioned the entire governmant plan and have decided to refuse EHR . I will take their penalty and keep devoting my time to my patients not to data processing. I enjoy the communication with my patients face to face, not while they are staring at my back. None of us have spent half our life preparing for a career as a data entry person!

    Should there be some type of group action?

  5. Todd Bragin MD January 26, 2013

    I am an ophthalmologist. I could not express myself any better and needed above individuals. Certain items that are absolutely required in my specialty in order to be compensated and to help my patients are simply not available in in the EHR format therefore I still have paper charts. In addition to my computer records, the one thing that I found to be extremely useful is the ability to electronically send in prescriptions for patients. No ophthalmologist that I know cares if a patient has gotten a flu shot other then in a conversational sense. Ditto for counseling people on how to stop smoking. Seriously? My counseling consists of telling people that they will die a miserable death if they continue to smoke.

    On any given day I have started to notice I am running a least an hour and a half to two hours behind and I am beginning to lose patience and patients. The whole concept of electronic charts may be wonderful for certain generalist practices but it is ridiculous for specialties in that there are not specialty specific meaningful use programs out there. If the government continues in this path they will have spent at least $15-$16 billion between the MDs, optometrists, psychologists, chiropractors, physical therapists, etc. I fear it that the only reason for the EHR program is that we make it very easy to be audited. Certainly the government has been finding out that most if not all practices encourage up coding and therefore will end up costing more in terms of billing. The government also has to keep in mind that if draconian measures such as additional cuts in reimbursement are used as the stick many physicians will simply leave Medicare and patients will have to pay the complete bill out-of-pocket.

  6. Nancy Neighbors, MD January 26, 2013

    I would argue that meaningful use has by and large been a good initiative. Granted, getting the connectivity issues worked out first seemed wiser. The networks are a mess and likely to continue evolving for decades. Many of these issues are political and will play out in their own space along with technology’s disruptions. The question “EMRs first or networks first?” represents the classic chicken and egg dilemma. Missing this point is to miss the complex dynamics of politics, technology and human nature. Still want to complain about the leadership? Who could have done better? The rush to collect incentives has been the biggest disappointment. Most loaded up on junk software. Greed is the Achilles heel of the MU gold rush. Given that 10% of users have been happy or very happy shows MU can be a benefit. Anyone unhappy may now kick themselves for buying unproven junk software.

  7. Michelle Snyderman January 26, 2013

    I echo Stephen Berman’s eloquently written concerns. I am a pediatrician with a special interest in development and behavior. The use of “bullet points” is entirely inadequate to portray a whole person and the psychosocial factors that affect their presentation.
    There are definite benefits to the EMR, but method of documentation that is most meaningful needs to be determined by the physician.

  8. Not one post on here about the benefits of Meaningful Use just complaining every post. Instead of working to manage the change it’s a festival of negatively themed blog posts…I don’t expect you to post this comment you only post the comments of those that echo your concerns. That’s not real dialogue you know…

  9. Meaningful Use..An Oxymoran..neithier meaningful or useful to patinents or physcians. The EHR on the other hand in a well implimented fasion is usefull and can lead to efficiency. I am also an Ophthalmologist and can say without a doubt that my current EHR can meet all my needs, needless to say it was a long road getting here. My first EHR was in 2000, woefully slow and not at all efficient! Yes it is a large investment, Approximately 70K in the end with me doing my own IT for the most part; which I hightly discorage. Stage 1 was a breeze, so will be Stage 2, I do not like Stage 3 as the sole purpose in my determination is to allow the goverment access to our data to figure out what they can deny! Medicine is an Art, they are trying to make it color by numbers. I sure we are all familiar with “best practices” and relize they are not always best for the patient only the statistician.
    I belive EHR can help us practice better medicine, Meaningful use on the other hand is only an actuarial excercise applyed in the misguided delusion that it will save money.

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