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Implementing “Meaningful Use” [A True Tale from the eHR Field]

11 Responses

1. Dr. Davidson, on February 12, 2012 at 1:23 PM said:

   ME-P

   A pragmatic object-lesson for us all. Thank you for real-life reporting; not sales or Federal bluster.

   Dr. Davidson

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2. Ann Miller RN MHA, on February 26, 2012 at 1:24 PM said:

   Proposed Stage 2 Requirements Raise the Bar for Providers

   The proposed Stage 2 meaningful-use requirements raise the bar for hospitals and eligible professionals on the use of computerized physician order entry, electronic prescribing and electronic recording of several patient-health measures, according to CMS officials. Just last Thursday afternoon, the proposed requirements were published on the Office of the Federal Register’s website. They are slated to be published in the Federal Register on March 7th, 2012.

   Under the proposed Stage 2 standards, hospitals as well as eligible professionals—the latter category includes physicians not employed by hospitals—would have to use CPOE for more than 60% of medication, laboratory and radiology orders, double the share required under the Stage 1 standards. The CPOE requirement is one of more than a dozen core objectives that hospitals and EPs would have to meet as part of demonstrating their meaningful use of electronic health-record systems, which would make them eligible to receive federal health IT incentive payments.

   Source: Christine LaFave Grace, Modern Healtcare [2/23/12]

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3. Darrell K. Pruitt DDS, on March 18, 2012 at 5:21 PM said:

   Meaningful mission creep in “Meaningful Use”

   A synopsis: “Health IT Meaningful Use Mission Creep” by Leslie Lenert and David Sundwall was posted on HeathAffairs Blog on Friday.

   http://healthaffairs.org/blog/2012/03/16/health-it-meaningful-use-mission-creep/

   “Health Information Technology (HIT or health IT) is one of the few areas where there is bipartisan agreement on investment in American society. In this article, we ask if the expanding role of Meaningful Use (MU) regulations is taking current Obama administration health IT efforts beyond their foundation of agreement into the soft sands of partisan politics.”

   Lenert and Sundwall describe five areas of concern:

   – Mission Creep Toward Guidelines For Care:

   “The evolution of MU regulations is clear: the regulations are not flexible checklists that allow providers and hospitals to demonstrate they that are using their IT systems in ways meaningful to them. Rather, the regulations are in fact guidelines on how providers and hospitals should appropriately use their IT systems.”

   – Mission Creep Beyond Evidence-Based Practice:

   “In our opinion, best practices for care will be evidence-based, and government policies regulating the practice of medicine should not outstrip the bounds of scientific evidence. Therefore, we ask, ‘Why isn’t MU driven by evidence produced by pilots and demonstration projects similar to the work of the Center for Medicare and Medicaid Innovation?’ and ‘Do we really need to move so quickly as to forgo a well-structured, evidence-based approach?’”

   – Mission Creep Into Risks To Patients:

   “Providers must be able to do things that make clinical sense in automation of clinical care processes. As currently structured, the Federal rule-making process is not sufficiently flexible to allow providers to modify implementation of ‘core’ MU regulations. This could pose a risk to patients’ health. If clinicians disagree with the assessment of risk to benefit from implementing a particular aspect of the MU requirements in their computer system, they should have time to evaluate the tradeoffs. There should also be a mechanism to appeal specific requirements, if in the judgment of a clinician they might be considered as posing a risk to patient care.”

   – Mission Creep Into Unknown Costs:

   “At the minimum MU policies should integrate with other government efforts to assess the comparative effectiveness of medical interventions and be judged by the same standards. Are MU regulations a cost-effective intervention?”

   – Mission Creep Into Expanded Bureaucracy:

   “This approach makes MU far more than an HIT adoption program. It is an ongoing regulatory program that significantly and permanently expands the federal role in healthcare and the federal bureaucracy. Accordingly, the ONC has created a Division (minimum size of 28 full time equivalents according to HHS regulations) to manage the growth of regulation on an ongoing basis, with an expanding staff of permanent federal employees. In short, what started off as a health IT adoption program is morphing into a permanent tool for regulation of medicine by federal rule-making. This takes MU beyond bipartisan areas of agreement on the role of government and possibly beyond the Obama administration’s own positions in other areas on the role of government regulation.”

   Darrell K. Pruitt DDS

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4. D. Kellus Pruitt DDS, on March 20, 2012 at 8:12 PM said:

   Meaningful Misuse of licensure laws

   As ARRA stimulus money is due to run out soon, forward-looking HIT stakeholders believe state licensure should become the incentive for Meaningful Use of EHRs by HIPAA covered providers with NPI numbers. HIT industry leaders are apparently growing impatient with doctors who have more important things to do than Click for Cash. What do you think?

   I recall that the first time I heard about linking HIPAA to licensure was during the 2008 Greater Southwest Dental Conference in Dallas. Delta Dental representatives who were handing out National Provider Identification (NPI) application forms, told dentists that they should apply quickly to avoid the rush, “since the NPI will be required for licensure anyway.” Perhaps the future will prove that the Delta representatives weren’t lying to dentists after all.

   Today, HealthImaging.com posted a short report on a recent study (which costs money to view): “Health Affairs: Docs need to learn more health IT competency earlier.” (no byline).

   http://www.healthimaging.com/index.php?option=com_articles&article=32806

   At a time in history when far too much of providers’ effort is spent trying to get paid for work done long ago, here are a few more regulatory suggestions from the authors of the Health Affairs study:

   Include health IT requirements in accreditation of curricula:

   Just as testing boards should hold students accountable for learning to become meaningful users of health IT, accreditation bodies should hold medical schools and teaching hospitals accountable for providing the underlying knowledge and skills. “To ensure that curriculum changes are meaningful to the experience of medical students and residents, focused questions on health IT could be added to standardized undergraduate and graduate medical education surveys,” the authors wrote.

   Require meaningful use of health IT as a condition of licensure:

   Because licensure policy is set by state governments in a deliberate, multistakeholder process, license boards may be best served by waiting for accrediting organizations and specialty boards to integrate health IT into their requirements before acting themselves. To avoid exacerbating physician shortages, such requirements could be phased in over time, taking into account specialty-specific and geographic shortages.

   Integrate assessment of health IT capabilities into board certification:

   In addition to obtaining a license to practice medicine in a given state, physicians often take exams to become “board certified” in a particular area of medicine, noted the authors. The American Board of Medical Specialties already has taken steps to incorporate health IT training and skills assessment into maintenance of board certification for primary care physicians.

   —————————

   Do you think these ideas will increase or decrease the education costs of doctors?

   A similar group of expensive thinkers who also do nothing to improve the quality of dental care says coding should be accepted as a specialty in medicine. Even as healthcare providers become scarce, HIT will provide lots of doctors.

   Look at it this way: If HIT proficiency becomes an unprecedented regulatory requirement for licensure, it’s sure to double the education of dental therapists.

   D. Kellus Pruitt DDS

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5. Darrell K. Pruitt DDS, on March 28, 2012 at 10:38 PM said:

   I don’t think it’s a joke

   At first, I thought it was a joke out of The Onion. But no. HHS is serious:

   “Latest healthcare ‘meaningful use’ rules require patient involvement”

   http://www.computerworld.com/s/article/9225599/Latest_healthcare_meaningful_use_rules_require_patient_involvement

   What could possibly go wrong with that idea?

   Darrell K. Pruitt DDS

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6. D. Kellus Pruitt DDS, on March 29, 2012 at 5:37 PM said:

   Clicking for Cash!

   Yesterday, I visited my LinkedIn HIT group where I am the least-liked member, and shared with them a ComputerWorld article titled, “Latest healthcare ‘meaningful use’ rules require patient involvement – Patients must access health information for providers to qualify.” I then asked, “What could possibly go wrong with that swell idea?”

   It was like a fart in church.

   This morning, Genevieve Morris, Senior Associate at Audacious Inquiry, LLC, responded: “You may want to reread the article you posted, there are a number of misrepresentations about how patients access their health information.” (Her complete reply can be found here):

   http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=104202753&gid=3993178&commentID=74609600&trk=view_disc&ut=26sYz6Cl1B0Bc1

   My response:

   I reread the ComputerWorld article, Genevieve, and it appears that you and the author Lucas Mearian are in stark disagreement concerning Stage 2 Meaningful Use requirement of patient participation in EHR communications. Nevertheless, there is one thing you said that we both agree: “(it’s really bad goal setting policy).”

   If I understand you correctly, Health insurance specialist Robert Anthony, who is repeatedly quoted in the article, misstated the facts when he told Mearian, “Clinics and private practices must also prove at least 10% of their patients are actually accessing healthcare information on EHRs.” The words “must prove” hint to me that this requirement might not be as passive for providers as you make it sound.

   Mearian adds, “Another core objective of Stage 2 is that eligible healthcare professionals prove that at least 10% of patients use secure, electronic messaging platforms that are native to EHR systems to communicate with healthcare providers.” Is that one of the “misrepresentations” you discovered?

   In response, Anthony elaborates, “This is just another instance of patient action being a requirement of meaningful use.” Yet you say that providers are only required to provide access, and it’s up to the patients to use it or not. I’m confused.

   Here’s something I didn’t suspect. The reward of stimulus money now, as well as the threat of fines after 2015, depend not only on cooperation of our patients, but also requires a quota of cooperation with other providers – but not just any providers. Mearian writes: “Another first for Stage 2 is that at least 10% of summary-of-care documents must be sent electronically to an unaffiliated healthcare provider with an entirely different EHR platform.” Wow! Where are the patients’ interests in all these dangerous, time consuming requirements?

   Anthony says, “The idea here is really to be moving beyond closed networks of information exchange.”

   It looks a whole lot like healthcare information technology has become the goal and healthcare communication the tool. We’re Clicking for Cash, folks! And the funds end soon.

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on March 31, 2012 at 6:49 PM said:

   Patient cooperation for MU
   [Stage 2 Meaningful Use requires patient cooperation]
   True or False?

   I’m still trying to get a definite answer to this question from Genevieve Morris, Senior Associate at Audacious Inquiry, LLC. As often happens with HIT topics, it gets complicated. Our conversation can be viewed in its entirety here:

   http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=104202753&gid=3993178&commentID=74884192&goback=%2Egmp_3993178%2Egde_3993178_member_104202753%2Egmp_3993178&trk=NUS_DISC_Q-subject#commentID_74884192

   ———————————

   Maybe we are just barely missing each other, Genevieve. Please hang with me as I try to sort it out.

   You say, “More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view and are provided the capability to download their health information.” That means Meaningful Use requires action on the part of patients.

   Health insurance specialist Robert Anthony agrees: “Clinics and private practices must also prove at least 10% of their patients are actually accessing healthcare information on EHRs.” Again, even though it’s only 10% (this year), proving Meaningful Use requires active involvement by patients who may not even care to view their charts.

   As you can see by Stage 2 EP Core Objectives 10 and 13 that Anthony presented in his webinar, he’s consistent:

   10. Provide online access to health information for more than 50% with more than 10% actually accessing

   13. More than 10% of patients send secure messages to their EP.

   Let’s suppose a minimal number of a doctor’s patients are required to view their medical histories online in order for the provider to win stimulus money now, or avoid fines after 2015. Imagine that the end of the reporting period is approaching, and it appears that the practice is falling shy of the quota of patient responses needed, and thousands of dollars hang in the balance. What do you suppose doctors will be tempted to do that is way beyond the tenets of the Hippocratic Oath?

   Going down a list of patients’ phone numbers asking for favors so a doctor can prove he or she uses EHRs in a meaningful way, probably won’t waste that much time, money and dignity. Who knows? Once a staff member explains the intricacies of “Meaningful Use” requirements over the phone, those that don’t hang up, might even be happy to help.

   Playing games like this with providers is actually sort of silly. Don’t you agree?

   D. Kellus Pruitt DDS

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8. D. Kellus Pruitt DDS, on May 3, 2012 at 7:30 PM said:

   The myth of Meaningful Use

   I’m part of the growing opinion that EHR Meaningful Use requirements are unreasonable, and the marketplace will inevitably prove it. The nonsense must stop, and the sooner the better.

   Just yesterday, “Health IT Break Sought for Docs in Small Practices” by Emily P. Walker was posted on MedPage Today.

   http://www.medpagetoday.com/PracticeManagement/InformationTechnology/32473

   “The chair of a House subcommittee on health technology has asked the Centers for Medicare and Medicaid Services (CMS) to exempt doctors in small practices or those who are nearing retirement from new health IT requirements.

   In a May 1 letter to CMS Acting Administrator Marilyn Tavenner, Rep. Renee Ellmers (R-N.C.) expressed concern about the ‘meaningful use’ requirements contained in the 2009 HITECH Act.”

   Ellmers told Tavenner, “I believe that modern, well-equipped offices are vital to the practice of medicine and that health information technology can help all health professionals to improve the delivery of care. However, I am concerned that the stage 2 goals may be too ambitious for some small or solo practice physicians to meet.”

   According to Walker’s article, in an April 30 letter to Tavenner from Rick Pollack, the executive vice president for the American Hospital Association, Pollack wrote: “Taken as a whole, the proposed requirements for meeting Stage 2 raise the bar too high and are not feasible for the majority of hospitals to achieve.” He adds, “The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity.”

   Those discouraging remarks come from the American Hospital Association. Consider how poorly HITECH must fit solo dental practices. Very few do, and boy-howdy does it ever show!

   If everything goes according to naïve stakeholders’ half-baked plans, as a provider, I may one day be forced to waste my time and patients’ healthcare dollars by entering Meaningful Use information on the internet – perhaps even information dental patients prefer I not share. After all, they don’t visit my office for MU service, and if they were asked for permission to needlessly send their Protected Health Information outside my office, a assure you that virtually all would understandably opt out. Here is my advice to dental patients: Sharing personal secrets over the internet is too high a risk right now. Besides, MU offers no reasonable hope of return in dental care anyway.

   What’s more, information demanded by those who would regulate healthcare is increasingly unlikely to be relevant to the wellbeing of dental patients. I offer as an example the Stage 2 requirement that providers must prove that 10% of their patients have e-Contact with their practices. One clever person who probably comes from a PR background suggested that doctors could easily fulfill the MU requirement by giving away i-Pod raffle tickets to patients who e-Contact the practice… for whatever reason. It doesn’t matter.

   Regardless, one can already tell by the accumulating delays in mandate deadlines that the wheels are falling off HIPAA/HITECH. Perhaps it will never really catch on in dentistry. Worse things could happen.

   D. Kellus Pruitt DDS

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9. Ann Miller RN MHA, on November 8, 2012 at 2:23 AM said:

   CMS: $7.7 Billion in EHR Payments Through September

   More than 300,000 physicians and other eligible professionals have signed up to participate in the federal electronic health-record system incentive payment programs, while more than 4,000 hospitals have enrolled in the Medicare EHR incentive program, the Medicaid incentive program, or both, according to the latest CMS data.

   In total, $7.7 billion has been paid out in what has been estimated will be $27 billion in incentive payments through the lives of the two programs. Physicians and other eligible professionals can enroll in only one program or the other. Of them, 208,331 have signed up for the program administered through Medicare, while 94,741 have enrolled in the counterpart Medicaid program.

   Source: Joseph Conn, Modern Healthcare [11/6/12]

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10. Ann Miller RN MHA, on January 24, 2013 at 10:53 PM said:

    ONC Admits Problems with EHR Test Tool

    The Office of the National Coordinator for Health Information Technology at HHS is acknowledging that some snags on its end are creating a bottleneck in its program to ensure that electronic health-record systems used by hospitals, office-based physicians and other professionals are able to help them meet Stage 2 meaningful-use criteria.

    The ONC sent a memo Thursday to five independent organizations testing and certifying EHRs for the program, acknowledging problems with custom-made software to be used by those organizations as well as software developers to test EHRs. ONC expects the coming fixes to a version of the tool that can be downloaded (a separate version is available to run online) should be completed by Feb. 15.

    Source: Joseph Conn, Health IT Strategist [1/24/13]

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11. Adam, on June 14, 2014 at 1:23 PM said:

    MU is not necessarily quality medical care

    Why achieving EHR meaningful use is not enough to improve quality.

    http://medicaleconomics.modernmedicine.com/medical-economics/news/why-achieving-ehr-meaningful-use-not-enough-improve-quality

    Adam

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