The Future of Meaningful Use

I had the pleasure of attending two meetings last week related to health care IT.

The first meeting was a 5-hour event sponsored by the Physicians’ Institute for Excellence in Medicine, a subsidiary of the Medical Association of Georgia.  The meeting was dedicated to helping medical practices achieve compliance with Meaningful Use (MU) guidelines.  A $4000 incentive was offered to cover expenses related to MU compliance.

The first speaker was the Chief Medical Officer of the Atlanta Regional Office of CMS.  He gave a nice talk that covered both the minutia of MU and the broader scope.  The talk was well received by the group of about 50 participants.  When his talk was finished he left the meeting.

With The Government no longer present, the mood slowly changed over the remaining hours.  This occurred as the following issues were reviewed:

–       Over 18,000 Georgia physicians were invited to the meeting.  Despite the financial incentive only 50 (including administrators) attended.

–       The sum of the number of installed users claimed by each of the top EMR vendors exceeds the number of practicing physicians in the U.S.

–       Only 4% of practices have a truly functional EMR.

–       As we go from MU phase 1 to phases 2 and 3, the requirements go up but the financial incentive goes down.


When the meeting began I assumed I was the only MU “doubter” in the room.   But as the meeting continued the level of trust within the group increased, and the comments became more candid.  Each of us gradually realized that everyone in the room felt the same way – we were all doubters. This is a remarkable process occurring within a group of docs and administrators that is presumably at the top of the bell curve on MU interest!  The meeting ran out of gas and most of the participants dispersed about 30 minutes before the meeting was scheduled to finish.

The second meeting, completely unrelated to the first, took place over lunch the following day.  I invited the CEO of a local health care IT company to meet some programmers that I know.  This company sells a very nice tablet device / service for automated paperless patient check-in.  The purpose was to build an interface for this product to work with our EMR.

After the introductions the conversation took off immediately and continued without interruption for nearly 2 hours.  The longer we talked the faster the creative energy flowed.  Finally we had to force ourselves to stop because everyone had other commitments.  The only mention of MU came when I raised a question.  The CEO made it clear he had no interest in MU and that his product was designed to avoid dealing with MU.

The contrast between these two meetings was striking.  Similar individuals – those who are motivated to become thought leaders in HIT and are willing to donate uncompensated time – attended both meetings.  In the MU meeting the conversation was limited to a single closed-end question:  How do we jump through government hoops to get the money?  The true benefits of EMR were never discussed.  Quality of care and practice efficiency were rarely if ever mentioned.  Individual motivation and creativity were stifled and replaced with frustration and, I think, a bit of anger.

The lunch meeting the day after had a completely different feel.  As creative minds gathered around the lunch table the brainstorming began immediately.  New ideas came fast and furious, and each was measured appropriately – by how it would improve practice efficiency and quality of care. Despite the inexperience and clumsiness of the facilitator (me), the meeting was a success.

My experience with these 2 meetings makes me wonder if the future of Meaningful Use is already in doubt.  The Medical Association of Georgia offers a free MU seminar with expense reimbursement, and 50 physicians out of 18,000 invitees attend.  And even these select few highly motivated MU candidates are already frustrated.  During the meeting we saw numeric evidence that some statistics that describe EMR use are grossly overinflated.

Our (soon to step down) government HIT leader Dr. Blumenthal has claimed “The Age of Meaningful Use” has begun, citing survey statistics that 41% of office based physicians plan to achieve MU.  It is hard to reconcile that number with statistics from the MU meeting showing only 4% of practices have a fully functional EMR.  The difference can probably be found in how the survey questions were worded in each case.  Assuming that achieving MU requires a fully functional EMR, how are we going to get from 4% (or let’s say less than 10%) to 41% by the end of 2012?  I don’t see that happening.   And even those practices that achieve MU stage 1 and get their (Medicare) $18,000 may walk away from the MU stage 2/3 requirements that will be tougher and offer less incentive.

Current interest in MU is driven by 3 forces:  1.  Government incentive programs generate interest simply because they exist; 2.  The monetary value of the incentives, and; 3.  The support of EMR vendors.  Those of us who have chosen to pursue MU despite our misgivings are doing so more out of a sense of duty and a desire for credibility than out of any true enthusiasm for MU.  But it won’t last forever.




About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.


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