Meaningful Use Rule: Initial Comments Set the Tone

It’s been a relatively quiet week—the initial reactions to the proposed rules on “meaningful use” and standards are out, and the flood of commentary has temporarily subsided. The work of reviewing and analyzing the rules in depth has just begun, as staff at various industry organizations pore over the 700 pages of government verbiage at a more detailed level to evaluate how their respective stakeholders will be affected. We are actively participating in such conversations, and a number of leading organizations—MGMA among them—have reached out to us to talk about the implications for physicians. I hope that they will take our input into account as they formulate their recommendations.

Although it is anticipated that the vast majority of public comments will not be submitted until the final days of the 60-day comment period—i.e., in early and mid-March—individual physicians and others have begun formally registering their opinions. Not surprisingly, some of the initial comments reflect anger about the length and complexity of the rules themselves. Urging the government to keep the requirements simple was a common theme among comments from physicians and administrators:

“If the goal is to get the majority of clinics using EHRs and to provide incentive funds to help the economy, then the first step of incentive payments must be easy to obtain.” —Craig Brauer

“The ‘meaningful use’ criteria should provide incentives to encourage the implementation of the most essential features of an EHR, but it is imperative that the ‘meaningful use’ criteria not become a Christmas tree of features that becomes hugely expensive and unworkable. The ‘meaningful use’ criteria must not make perfect the enemy of the good.” —Robert Rauner, M.D.

Others talked about the limitations of traditional EHR products and issues of usability:

“I am concerned that the current emphasis, promoting adoption of existing EHRs, with little focus on the need to make EHRs better, will ultimately slow innovation. . . . Usability is the Achilles heel of current EHRs. An EHR may meet all of the functionality requirements and yet be so burdensome to use that patient care is made more difficult. . . . At this point we don’t need more EHRs, we need better EHRs.” —Christine Sinsky, M.D.

Objections to CPOE and the effect on physician productivity were also common:

“The process of entering orders is often inefficient and time consuming, with multiple screens, drop-down boxes, scrolls, and clicks. Assigning these clerical tasks to physicians results in a redirecting of limited physician resources away from clinical work, replacing direct patient care with low value added clerical work.” —Christine Sinsky, M.D.

To view these and other comments, or to submit your own recommendations, go to regulations.gov.

On a lighter note, a few days ago, I read a parody in HIStalk (a venerable healthcare IT blog) called “Marry in Haste, Repent at Leisure: Choose Your EMR Soul Mate Carefully.” It compared purchasing an EMR to getting married, and the analogy is a good one. Mr. HIStalk, the blog’s author, postulated that “the same handful of wrong reasons that convince people to marry unwisely also convince them to buy EMRs that will make them unhappy.” If you are interested in reading more, go to HIStalk.

As Promised, Your Voice Was Heard

At Friday’s HIT Policy Committee meeting, SRSsoft Vice President of Government Affairs, Lynn Scheps, presented the Voice of the Physician petition to David Blumenthal, M.D., National Coordinator for Health Information Technology, and to each member of the committee (see pictures below). Lynn went to Washington, D.C., to make sure that the decision-makers heard your voice loudly and clearly—she urged them to read the petition and to heed the comments submitted by SRS clients and the comments written by non-SRS users. Taking the microphone, Lynn addressed the group with the following statement:

Presentation of the Voice of the Physician to the HIT Policy Committee
August 14, 2009

I have attended your past meetings via webcast, but I felt it was important to be here today to personally deliver this book, which you received this morning. The Voice of the Physician is a petition asking you to listen to private-practice physicians, on whose participation the success of the program depends. These are the physicians who will have to “achieve” what their EHR only has to be “capable of achieving.” They implore you to consider the daily realities of medical practice as you move forward.

The fact that a relatively small company like ours would receive such a response in just a few weeks, with minimal outreach efforts, is an indication of the deep level of concern pervading the physician community. Two things are clear: Physicians feel that their voice is not being heard and they perceive the government’s expectations as overly burdensome from a practical perspective.

The signers of this petition are not all SRS clients. Other providers reached out to us and asked that we stand up for them as well. SRS users or not, they are passionate about EHRs, and they speak from positive and negative experience with a variety of EHR products. Three fundamental themes dominated:

  • Physicians will not adopt technology that compromises their productivity,
  • They will not become data entry clerks, and
  • They will not jeopardize the physician-patient relationship.

No financial incentives or penalties will persuade these physicians to take actions they deem detrimental, or not valuable, to their practices.

One hundred and fifty of the signers of the petition are so concerned that they took the time to compose their own supplemental comments for you to consider. I hope that you will take the time to read through even a portion of them—their tone, intensity, and content provide valuable insight into what will be necessary to successfully encourage widespread EHR adoption.

Lynn Scheps, VP Government Affairs, SRS

SRS Vice President of Government Affairs, Lynn Scheps, distributes petition

Petition Distribution

The petition alongside the meeting agenda