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On Track for Meaningful Use?

Are we on track to be a huge disappointment to our children’s children – or What?

[By Darrell K. Pruitt DDS]

When our grandchildren get the bill for the Obama administration’s subsidies benefitting primarily the health information technology industry, I bet they’re going to be really, really pissed at us for allowing today’s lawmakers to blow their 28 billion dollars to please HIT advocates who mislead consumers as well as lawmakers about the benefits of EHRs.

The Doctors Speak 

According to physicians who actually do the hard lifting in healthcare, the “meaningful use” requirements that they must prove in order to qualify for stimulus money will arguably increase both the cost and danger of healthcare – all for the benefit of stakeholders rather than principals. For one thing, “meaningful use” is meaningless if it fails to help physicians treat their patients. I think HIT stakeholders’ grandchildren should somehow be held accountable to my grandchildren.

Opposing Opinions  

Just days apart this week, two HIT reporters, Rich Daly from ModernHealthcare.com and Joseph Goedert from HealthDataManagment.com described two opposing letters the Office of the National Coordinator for Health Information Technology (ONC) recently received: One from doctors and one from patients (et al).

On Monday, here is how Daly’s article “AMA to ONC: EHR program doesn’t work for docs” began:


“Many physicians—specialists in particular—will not participate in the federal electronic health-record adoption incentive program because it requires them to include patient data that they do not otherwise collect, according to a Feb. 25 letter from 39 medical organizations letter to the Office of the National Coordinator for Health Information Technology”

On Wednesday, Joseph Goedert, writing for HealthDataManagment.com began “Consumer Groups: Hold Strong on MU” with this:


“A coalition of 25 consumer groups and unions is asking federal officials to hold firm on more stringent criteria for Stage 2 of electronic health records meaningful use, and expressing support for going further. For instance, because patients still trust their providers more than other information sources, holding providers accountable for actual usage of a patient Web portal ‘is entirely appropriate and we strongly urge ONC to resist pressure from the provider community to absolve them from responsibility for making these services available and useful to their patients,’ according to a comment letter to the Office of the National Coordinator”

  • AARP
  • Advocacy for Patients with Chronic Illness, Inc.
  • American Association on Health and Disability
  • American Hospice Foundation
  • Caring from a Distance
  • Center for Democracy & Technology
  • Childbirth Connection
  • Consumers for Affordable Health Care
  • Consumers Union
  • Families USA
  • Family Caregiver Alliance
  • Healthwise
  • Mothers Against Medical Error
  • National Alliance for Caregiving
  • National Coalition for Cancer Survivorship
  • National Consumers League
  • National Family Caregivers Association
  • National Health Law Program
  • National Partnership for Women & Families
  • National Women’s Health Network
  • OWL – The Voice of Midlife and Older Women
  • SEIU
  • The Children’s Partnership

Like the “Record Demographics” MU mandate, this is all for the “common good” I suppose. Consumer Advocasy groups wouldn’t mislead patients, would they?

I doubt many Americans represented by these 25 organizations ever imagined a new federal requirement that doctors record each patient’s demographics. (Notice of Proposed Rulemaking: Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Federal Register / Vol. 75, No. 8 / Wednesday, January 13, 2010 / page 1861; RIN 0938-AP78).

This means that the 25 stakeholder groups are doing their best to help American taxpayers hold physicians accountable to record and share their patients’ demographic information with the US government – private information about me and my family members that I personally don’t trust the government to be given – even if I’m in vulnerable need of health care.

Daly’s Article 

According to Daly’s article, the demands of MU are distractions for increasingly busy doctors and staff whose focus, I believe, should include eye-contact with patients with specific health problems rather than irrelevant data needs of third parties, including consumer advocacy groups.

On the other hand, if consumer advocacy groups have successfully defined for the federal government what clueless patients allegedly need, who will the mandate really benefit? 25 consumer advocacy groups don’t equal one consumer, so their letter isn’t grass roots at all. It’s deception wearing lipstick. Gullible and vulnerable patients are again being misrepresented by HIT stakeholders for a cut of our grandchildren’s 28 billion.


Finally, if MU requirements are an arguably expensive and dangerous distraction for physicians, how can the law possibly be any less absurd for dentists? I’ll look at meaningful use as well at the ADA’s apparently flagging commitment to EHRs next. The ADA is abandoning state informatics departments – leaving them exposed to ADA members’ questions they are unable to answer. It looks to me that intra-ADA relationships are deteriorating quickly, but nevertheless, traditional stoicism still hasn’t been broken. “Image is everything” – ADA/IDM slogan.


Here’s a teaser, dentists: Chances are, your state ADA organization hasn’t yet shared with you how the MU requirement of CPOE (Computerized physician order entry – page 1858) will change your practice communications. If you are a HIPAA-covered entity with an NPI number and you don’t email instructions to your denture lab rather than include a hand-written note with the relevant patient’s plaster models, you won’t qualify for stimulus money. What can possibly go wrong with that meaningful idea?


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18 Responses

  1. Meaningful-use Attestation Starts April 18th, 2011

    The window opens April 18th for eligible professionals, hospitals and critical-access facilities to line up and attest that they’ve met their respective meaningful-use criteria and are eligible to receive Medicare incentive payments for the installation and use of electronic health-record systems under the American Recovery and Reinvestment Act of 2009.

    During this first year of the Medicare program, both eligible professionals and hospitals must attest that they’ve met the criteria for 90 consecutive days. Registration opened in January for both eligible professionals and hospitals for the Medicare EHR incentive program.

    Source: Joseph Conn, IT Strategist [3/28/11]


  2. MU is Tough

    While a majority of medical practices (80 percent) that have adopted electronic health records (EHRs) say they intend to participate in the EHR Meaningful Use incentives, only 13.6 percent at the current time indicate that they are able to meet all 15 core criteria for eligibility to receive those payments, according to this new survey and report from the Medical Group Management Association (MGMA).




  3. Medicare Attestation Statement

    Darrell – Attestation for the Medicare Electronic Health Record (EHR) Incentive Program will begin on April 18th, 2011. The Centers for Medicare and Medicaid Services (CMS) has published a step-by-step Medicare user guide and webinar to help physicians register and successfully attest.

    Physicians are being encouraged to register as soon as possible, even if they do not yet have a certified EHR or enrollment record in PECOS.




  4. Waiting on Meaningful Use

    The Chief Medical Information Officer [CMIO] for inpatient services at Henry Ford Health System discussed the Michigan system’s decision to hold off on applying for meaningful use funding in 2011, and what that means for its long-term vision of connecting clinical goals with IT support.

    Podcast: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=4620008509

    Related info: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2010/1210HHN_Fea_EDHealthIT&domain=HHNMAG



  5. Darrell,

    Did you know that the Health IT Policy Committee’s Meaningful Use (MU) work group is discussing whether it would make sense to delay by one year–until 2014–the beginning of Stage 2 of the MU program?


    Now … are you surprised?



  6. Thanks for the info, Barbara

    It’s obvious that this is not the time to be an early adopter of digital records. This looks like chaos to me. So where is the leadership?


  7. Is Meaningful Use actually meaningful?

    It looks to me like the headaches of achieving Meaningful Use with a certified EHR system are going to last longer than the stimulus money.

    “Certification Regulations Complicate Meaningful Use Program,” by Protima Advani, was posted on iHealthBeat today.


    “Of the three tenets of meaningful use — adopt certified electronic health record technology, demonstrate core and menu set requirements, and report on clinical quality measures — the piece about adopting certified EHRs is more complicated than most health care providers anticipated.”

    D. Kellus Pruitt


  8. Beware Cost of MU and ACOs

    The feds want your involvement in Accountable Care Organizations and Meaningful Use, but will you see a meaningful return on investment?




  9. Understanding the $44,000 EMR Incentives

    The American Recovery and Reinvestment Act (ARRA) includes significant incentives for medical professionals who provide Medicare or Medicaid services and use an Electronic Medical Record (EMR).




  10. E-Prescribing Threshold Too Low To Reduce Deaths
    [RAND Study]

    Higher requirements for Meaningful Use could decrease heart attack, heart failure, and pneumonia mortality, say researchers, but as a hospital executive, I and others remain skeptical.




  11. $653 Million Dollars in eHR Incentives Paid by CMS

    The federal government has paid out more than $653 million for electronic health-record system incentive payments to programs under Medicare and Medicaid, according to the latest data from the CMS.

    The programs, created under the American Recovery and Reinvestment Act of 2009, have registered 90,650 organizations or individual providers through Aug. 31, the CMS reports. There have been 4,463 physicians and eligible providers paid $93.9 million under Medicaid, according to the CMS.

    Source: Joseph Conn, Modern Healthcare [9/22/11


  12. Podiatrists Take Early Advantage of eHR Stimulus Payments

    A disproportionate number of those receiving the first batch of incentive payments to install electronic health records are podiatrists, an iWatch News analysis suggests. Of the 188 different practices and chains that received the first batch of payments in May, 23 were podiatry practices, or about 12 percent — even though podiatrists make up only about 1.5 percent of Medicare physicians and practitioners.

    Those numbers are no accident, according to Dr. James Christina, himself a doctor of podiatric medicine and director of scientific affairs for the American Podiatric Medical Association (APMA), the national professional association for podiatrists.

    The APMA, Christina noted, has made a “very directed effort” to educate its members about both health information technology generally and how to meet requirements that providers demonstrate “meaningful use” of health IT in order to receive the incentive payments.

    Source: Josh Israel and Kimberly Leonard, iWatch News [10/12/11]


  13. Government Misses Deadline for Rules Forcing Disclosure of Industry Payments to Doctors

    The Obama administration has yet to draft rules on the disclosure of industry payments to doctors, missing a deadline set out in last year’s health-care law.

    Drug and device companies, which are required to begin collecting payment data starting next year, are still awaiting such guidance.

    Co-incidental to the above comments?




  14. HHS Extends a Meaningful-Use Deadline

    HHS has extended until 2014 the compliance date for Stage 2 meaningful use for those hospitals, physicians, and other eligible professionals who qualify as Stage 1 meaningful users in 2011. The announced rollback came in an HHS news release about a visit by HHS Secretary Kathleen Sebelius to Cuyahoga Community College in Cleveland to discuss health information technology’s role in job creation.

    Under the current rules for the Medicare portion of the electronic health-record system incentive program created under the American Recovery and Reinvestment Act of 2009, hospitals, doctors, and other eligible professionals who qualified for incentive payments as Stage 1 meaningful users in 2011—the program’s first year—would have to meet new and expectedly more stringent Stage 2 standards in 2013.

    According to HHS’ statement, if those providers had delayed participation until 2012, “they could wait to meet these new (Stage 2) standards until 2014 and still be eligible for the same incentive payment.”

    Source: Joseph Conn, Modern Healthcare [11/30/11]


  15. Early EMR Adopters Get a Break – Tougher Criteria Delayed to 2014

    Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

    The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

    Source: Charles Fiegl, AM News (12/12/11]


  16. Cardiologists and Podiatrists High on List of Specialists Receiving EHR Stimulus Money

    It has been said that physicians are unlikely to receive the promised incentive funds for adopting electronic health records (EHR) technology and attesting to meaningful use. This, however, clearly is not the case. In October alone, the government paid out more than $36,500 in EHR adoption funds to qualified physicians.

    In 2011, more than $104,490 was paid out to just 5,805 healthcare providers. This amount doesn’t even include Medicare-only hospitals or Medicare/Medicaid hospitals.

    This amount covers payments to individual healthcare providers working in family practice (1,216), internal medicine – cardiovascular disease (1,198), cardiology (517), podiatry (378), gastroenterology (232), orthopedic surgery (201), general surgery (197), urology (197), nephrology (174), and neurology (148).

    Source: Medical Economics [1/10/12]


  17. Number of Providers Facing Stage 2 EHR Hurdle Puts Billions at Stake

    Billions of dollars in federal electronic health-record incentive payments appear to be in jeopardy as hospitals, physicians, and other eligible professionals who got an early start on the payment program face a more stringent set of criteria this year, according to a Modern Healthcare analysis of new CMS data. So far, only a tiny fraction of participants have met the benchmarks.

    There are approximately 2,500 eligible hospitals and 168,000 physicians and other eligible professionals that met Stage 1 requirements in 2011 or 2012, and remain eligible for program participation this year. But few of those providers have cleared the Stage 2 threshold—about 3.1% of hospitals and 1.1% of physicians and other professionals. That means roughly 2,400 hospitals and 165,000 eligible healthcare professionals remain at risk for losing additional EHR incentive payments this year, not to mention incurring Medicare reimbursement penalties in 2015 and beyond.

    Source: Joseph Conn, Modern Healthcare [8/15/14]


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