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Curbside Consult with Dr. Jayne 5/7/12

May 7, 2012 Dr. Jayne 2 Comments


Have You Been Meaningfully Used?

I recently attended a continuing medical education seminar. On breaks, people normally stand around tables of stale baked goods and institutional coffee, complaining about the twin threats of Medicare and Medicaid. Sometimes we gripe about the venue (in this case, a hotel which had smooth jazz versions of “Like a Virgin” and “Personal Jesus” playing in the lobby – the horror, the horror.) This time, every conversation seemed to revolve around Meaningful Use.

I felt like I was back in medical school again, with everyone standing around the Dean’s office wanting to look at the posted exam scores in hopes of determining who was the smartest in the class. Instead of comparing microbiology vs. pathophysiology it was:

  • Have you attested yet?
  • When did you attest?
  • How much money did you get?

Surprisingly some attendees were still in the process of transitioning from paper to EHR. Almost half of those that I chatted with still planned to attest this year in hopes of assuring their full MU payouts. At least two-thirds of those people were completely oblivious to what it actually takes to be successful when implementing an electronic health record.

Having been in the CMIO trenches for some time, I’m fully aware that the risk takers and early adopters are long gone. What we are left with are large numbers of physicians who are only going to EHR because (a) they want the MU money; (b) their health system or employer is forcing them to change; or (c) they’re afraid of future penalties.

In my experience, the early adopters really wanted to transform patient care. Their goals were to improve quality and patient outcomes and the EHR was a tool to that end. These users are now reaping rewards with quality recognition and have the ability to demand higher levels of reimbursement from third party payers.

Many of the users we now see implementing EHR are merely trying to meet the MU requirements. It’s the healthcare IT equivalent of sitting in class and only taking notes when the teacher specifically says something will be on the test.

Most disturbing were the physicians I spoke with that were acutely aware of the fact that other than a few things, they didn’t even have to use the EHR to meet Meaningful Use. Their staff members would do pretty much everything other than the CPOE requirement. While meeting the letter of the Rule, they certainly aren’t meeting the spirit or doing any great service to their patients.

Interestingly, I was not only an attendee at the conference, but also a speaker. My nametag, though, didn’t give that fact away, allowing me to gather lots of interesting anecdotes before speaking on Day Three of the conference. My topic was practice transformation through EHR adoption. It was great to see some of the looks on the faces of those who had previously admitted they didn’t care about anything other than achieving MU.

True meaningful use (the non-capitalized variety) involves transforming the practice of medicine to better serve our patients rather than doing the bare minimum. It’s not about a federal program or a software package. Until we reach that understanding, we just feel used and not in a particularly meaningful way.


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Currently there are "2 comments" on this Article:

  1. Sadly, many doctors see Meaningful Use as far from meaningful use of an EHR and so the incentives distract from the transformation of the practice. Or in the worst case scenario actually transform it in a negative way.

    I’m not sure why you were surprised that many were still in the process of transitioning to EHR. Many haven’t even started the transition.

  2. What can be frustrating is when, as a clinician, you are ready to make the EMR meaningful, but the vendor is not there yet. I have the pleasure of pushing the prescribers to move their problem list into a very specific discrete data field in our system. As I ask them to change their workflow, they ask me what is meaningful about placing their problem list here rather than where they have been keeping it. All I can tell them is that “someday” we will be able to drive decision support from the problems identified, but not today. Today we are just doing it to disrupt your workflow and meet meaningful use criteria.

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