I’ve been promising some more detailed coverage on Meaningful Use for a little bit now. I’ll admit that life has been busy, but I’ll also admit that the amount of information out there on Meaningful Use is also a bit overwhelming. However, consider this the start of my coverage of meaningful use. This is still kind of general, but should get us started down the path of meaningful use (I hope).
First up, I’ve already created a meaningful use post with links to all the official documents related to meaningful use. So, go check that out if you want the full details on what’s being proposed. Also, check out some of my other coverage of meaningful use on EMR and EHR.
Now for a summary of a number of themes I’ve found people talking about in regards to meaningful use:
Meaningful Use Needs to be Simplified – The only people I’ve found who think this is a great piece of work are really vendors that are trying to hop on the ARRA stimulus money band wagon. Hopefully enough people will comment to ONC/HHS that this will become a reality. If this doesn’t happen, I predict major problems with this legislation
Small Clinic Challenge – I’m not sure how purposeful this was or not, but looking at the criteria I think it’s clear that small clinics are going to have a huge challenge meeting meaningful use guidelines. Large clinics are going to have a real challenge with meeting the proposed criteria, but small clinics are going to have a really hard time with this.
Benefit to Doctors – I hope that someone takes the time to do a detailed analysis of the criteria and evaluate how the various meaningful use criteria will benefit doctors. If no one else does, then I’ll see what I can do to evaluate it. However, on first analysis the criteria seems like it won’t make physicians better at their job. I’ve always said that improving physicians lives should be a key part of any effort to encourage EMR adoption. This seems lacking from the meaningful use criteria. Look forward to more coverage on this topic.
Few Details for Specialty Providers – I’d really hoped that meaningful use for specialties would be clearly defined. As best I can tell, it looks like there’s been little direction given in regards to specialties meeting the various meaningful use objectives.
Few Details on Measurement and Reporting Methods – I’m guessing that more of these details are forthcoming, but I’m just absolutely amazed that with 692 pages of information there aren’t more practical details of how people will be able to show meaningful use and how HHS/CMS/ONC is going to verify that clinics are actually meeting the meaningful use objectives. Maybe I shouldn’t be surprised since it is government work. However, that doesn’t make it any less disappointing.
Now for my biggest concern of all…
Little Hope the Little Guy Will be Heard – I already provided my first lament about providing meaningful use feedback being difficult. However, I’ve started hearing a chorus of people around the internet expressing feedback that doctors, smaller EMR vendors and other EMR participants aren’t being listened to by the powers that be. Sure, there’s a place on the HHS website to provide feedback. The question is will it be heard? Or as one EMR vendor emailed me, “So, I could make my comments, but will anyone really listen to little old me?”
I’m not sure the solution to this problem, but I’m interested in participating in a solution. Do we flood the HHS comments with this type of commentary? Do we flood PR channels about it (Will they care about only $18 billion?). Do we not concern ourselves as much with transforming governments definition of meaningful use and instead focus on a movement to educate people on meaningful use and the challenges associated with the EMR stimulus money and how EMR can benefit them regardless of EMR stimulus money? Please share your ideas.
Along these lines, I’d be very interested in publishing well thought out feedback that’s being submitted to HHS about meaningful use. Maybe that’s one way to start a broader discussion about meaningful use and the EMR stimulus money.
John:
Here’s an initial, non-exhaustive list of the benefits of MU for physicians:
1. It helps them do a better job. The clinical decision support, including the drug interactions checking, will help them prevent medication errors, for example.
2. It helps them participate more effectively in maintaining and improving public health. The required connections with public health agencies, vaccine registries etc. will help them detect and report on of disease outbreaks, bioterrorist attacks etc…and help them monitor the efficacy of public policies on the matter (e.g. H1N1 vaccine distribution, side effects etc.)
3. It helps them communicate with patients. There are 4-5 criteria in MU that assure better interactions w/patients (which also has the benefit of empowering the patients themselves).
This doesn’t address financial benefits associated with HITECH incentives themselves, which can amount to quite a bit of dough…a practice with 2 docs and one nurse practitioner, for example, can get $132,000 if they meet MU criteria. This $$ can be pocketed if the EHR is free.
Thanks
Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs
Practice Fusion
http://www.practicefusion.com
Free Web-based EHR
John, I’m curious why you think small practices will have a difficult time meeting meaningful use. If they go with a “meaningful use guarantee” EMR software vendor, what specific problems will they face? Would it be the high cost of systems? Thanks.
Eunice
Eunice,
There’s a lot of reasons, but I won’t go into all of them here (since I only have a little time). However, I will address the “meaningful use guarantee” EMR vendor part. Check out the fine print of any of those guarantees and you’ll find that they guarantee that their system will be eligible to receive the money. They don’t guarantee that you’ll get the money. Every one that I’ve seen has a nice clause in there that says that if you don’t perform everything right on your side, then they aren’t required to guarantee the stimulus money. So, basically, they might have the function to meet meaningful use, but you’re going to have to know how to use all those functions and that you use those functions in the correct way to get the stimulus money. Otherwise, you won’t get the stimulus money and you won’t get the guarantee from your EMR vendor either because you didn’t do your part.
When I have a second, I’ll try and look through the objectives and give a concrete example of how this might happen. Watch for it in a future post;-)
Aha. This makes sense. The situation seems to provide opportunities for consultants to help small practices do their part to meet meaningful use. Hopefully some good summaries have been/will be written about what doctors need to do on their end. Eunice
This is one of the criteria for meaningful use…
“…Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules… …We propose to describe clinical decision support as a health information technology functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.”
Does anyone know precisely what is meant by “Implement five clinical decision support rules?”
Hayward,
I can think of some examples of what it might be, but what HHS will require is still a guess I think. I seem to remember reading somewhere that they were going to specify different clinical decision support rules based on the specialty as well. Sadly, one of those wait and see ones I think.
[…] on here as I send them to the government. I think my first submission will be these thoughts on Meaningful Use and then follow it with my own thoughts on the harmful effects of meaningful use. Related […]
The question is whether the incentive payments from Meaningful Use (75% of Medicare Part B income for each “eligible practitioner,” up to $44,000 over 5 years) offset the cost of the MU-certified EHR installation, maintenance, and reporting activities + revenue losses from the 21% decrease in Medicare reimbursement to physicians due to go into effect next month under the SGR (Sustainable Growth Rate) legislation.
See this Grand Rounds, which discusses the details physicians will need to understand and “do” in order to achieve “meaningful use”
http://www.screencast.com/users/ComChart/folders/PCEMRS.COM/media/6ebaa5ff-fc54-4da1-b68b-2403318c30dd
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