Doctors, Is Meaningful Use That Important?

According to an estimate I heard recently, if a doctor’s productivity drops as little as 3 percent to 5 percent the first year after installing an EMR, they’ve already lost more than the $40,000 they can make from Meaningful Use incentives.  And while there will be exceptions, I can’t help but think that most practices will fall into that category.

After all, EMRs aren’t just new software. They represent a new way of thinking about workflow and the practice of medicine generally.  While that may ultimately be a good thing, over the short term it’s likely that even tech-friendly doctors will need some time to adjust.

So, why are medical practices worked up over MU compliance? Certainly, it doesn’t hurt to stay on CMS’s good side, and the $40K sounds sweet at the outset. Also, I’m sure some practices genuinely believe that EMRs can improve the quality of care they provide — and see the incentives as an added benefit.

That being said, I’d argue that the hunger for Meaningful Use incentives puts far too much pressure on doctors, pushing them to make EMR buying decisions before they’re prepared.  Choosing a piece of enterprise software is tough enough even in hospitals with veteran IT teams in place; for smaller practices, which may not have even a single tech on staff, it’s even riskier.

If I ruled the world (OK, even HHS), I’d spend more on bringing vendor selection, training and change management support to doctors, and focus less on payoffs. But as things stand, CMS seems largely focused on handing out the cash. All I can do is encourage doctors not to be blinded by short-term gain, and phase in EMRs at their own pace.  For most practices, I’d argue, that will work much better over the long run.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

6 Comments

  • The biggest problem is the current crop of EMRs is not flexible or sophisticated enough to support our workflow. If it worked, we would use it. No incentive necessary. Imagine if someone forced you bloggers to use Netscape for all your blogging. That’s what it’s like for us.

  • I think some time back John had posted the advantages of EHR; and that has not changed at all. Just for those who did not have a chance I am listing it once again:
    1. Legibility of Notes – Not having to deal with handwriting styles since notes are typed reduces errors; need for additional clarifications and related work is reduced substantially.
    2. Accessibility of Charts – Charts are indexed and easily searchable by multiple identifiers. No more searching the entire clinic for a lost paper chart, leading to reduced work and increased efficiencies all around.
    3. Multiple Users Access a Chart Simultaneously – EHRs support multiple users accessing a chart at the same time.
    4. Transcription Costs Savings – Many Providers have been able to save on transcription costs by implementing EHR with specialty specific templates ‘ready to go’. This not only reduces the transcription related costs, but also increases operational efficiency by reducing delays related to transcription process.
    5. Lab Orders and Results – Substantial administrative work is performed with lab orders written and results received manually. Receiving lab results via fax, losing some of those results, call backs, identifying related patient charts, presenting results to Physician along with Patient Chart for review, etc., are tasks avoided. EHR’s capabilities of bi-directional data flow, auto-populates results inside patient chart with a message for the Physician to review.
    6. Lab Results received as ‘Structured Data’ – Results from labs are received as structured data into the patient chart; it facilitates ability to perform trending analysis and analytics with just a few clicks.
    7. MRI Results – Depending on the MRI Center’s PACs and RIS interface, EHR derives same possible benefits as in a lab interface.
    8. Cost Controls – Better communications lead to more informed decision making process, eliminating wasteful events along the way including but not limited to duplicate tests.
    9. Redeploy Staff to Productive Tasks – Although this may not happen immediately, this happens over time; this is usually possible with front desk or medical records staff that can be re-deployed to patient care and/or related revenue generation activities.
    10. Possible Eligibility for Pay-for-performance – EHR enables practices to implement a meaningful quality improvement mechanism and more importantly achieve ability to measure quality in quantitative terms, which in turn would lead to additional incentive payments from programs such as Pay-for-Performance (P4P).
    11. Electronic Prescriptions – Scripts are sent electronically and/or printed avoiding problems of legibility by the pharmacy receiving the script avoiding call backs, staff time, etc. More importantly, list of active and in-active medications are maintained, enabling clinical decision support systems to perform drug to drug and drug to allergy reactions automatically leading to reduction in possible errors due to oversight
    12. Disaster Recovery – Depending on EHR vendor and their backup schedules, data is stored in multiple locations for better disaster recovery. Compare this to carrying a room full of charts in an emergency such as Katrina or even smaller events.
    13. Quality of Care – With computerized access to patient data, practicing preventive care becomes that much easier and efficient, without having to manually track patient well being.
    14. Increased Efficiency through Improved Workflow – Simple but efficient functions such as secure internal messaging enables efficiencies in communication. Tasks such as referring a patient to a specialist can be performed by one click, sending the patient records to the specialist without having to involve the administrative staff to locate the patient chart, fax the relevant pages, confirm with the specialist’s office if they are in receipt of those documents, etc.
    15. Improved Accuracy of Coding Evaluation, Charge Capture and Financial Management – With comprehensive and integrated billing & financial module, accuracies and efficiencies increase through the seamless flow of data – from the patient chart to billing module. Such information is available to perform analytics, helping in yearly review with payers; having all the required information on finger tips is useful in such negotiations. This leads to informed discussions and decision making process based on documented facts.
    16. Improved Claim Submission Process – Claims submission process is simplified; experience of Physicians who have implemented a comprehensive EHR with integrated billing system suggests that the claims are submitted soon after the patient encounter is complete. ‘Ability to submit a claim before the patient can tie his/her shoelace’ is a reality.
    17. Reduced Medical Records Transportation Costs – An additional benefit, where costs add-up over time to significant dollar numbers.
    18. Space Savings – Many practices are able to save space where they’d normally be storing shelves of paper charts, reclaiming prime real estate; this includes the off-site storage areas required to store archived paper charts.
    19. Save a Tree – Grow a Tree – Its common understanding that use of paper may not be eliminated 100%; it’s bound to happen some time in the future; however use of paper is significantly reduced by effective deployment of EHR.
    20. Mal-practice and Liability Insurance – Insurers are evaluating the effect of EHR in Practices; many insurers are also in the process of quantifying reduction in risks. Over the next two years such insurance products will be re-priced to reflect the actual benefits of EHR and how it reduces risk in patient care. Although empirical data is not available currently, this is a change that’s in progress. Practices that have implemented EHRs and are meaningfully using them will stand to benefit with such macro-industry changes.
    21. Data Analytics leading to improved Patient Care – This is by far one of the most important benefits of implementing EHR in any ambulatory care setting. The ability to access data and more importantly the ability to slice and dice such data is a benefit that leads to higher efficiencies in patient care.
    22. Convenience – This is a direct benefit to Providers and associated Staff; ability to access data from anywhere, anytime, through multiple devices, is a convenience. Access to data through multiple devices certainly enhances quality of life for the busy providers.
    23. New Physician Recruitment – Many new physicians, already used to ‘all things digital’, positively look at EHR as a differentiator. New Physicians are looking for practices that ‘meaningfully use’ EHR and will only consider an organization that embraces technology and Health IT in specific.
    24. Competitive Advantage – A comprehensive EHR includes well rounded patient portal. Overtime, practices that provide patients access to their health related data will have a competitive advantage over practices that do not provide such convenience. With the referring physicians EHR will presents a competitive advantage.
    25. Increased Revenues through eConsults – Few commercial payers have been accepting and paying claims for eConsults. This is expected to go mainstream over the next 24 months and practices who have embraced EHR will stand to benefit.
    26. Maintenance of Immunizations Records in Pediatric Care -.Using an EHR system ‘meaningfully’ in pediatrics care is an important catalyst in reducing medication errors. One of the key challenges for pediatric providers is compliance to vaccination recommendations. Paper-based immunization records do not allow for population-based monitoring, quality control and further analytics to be performed for data mining. EHR system with immunization registries, built as an integrated systems with clinical decision-support and reporting capabilities, offer tremendous potential in tracking and improving the rates of adherence to recommended immunization guidelines
    27. Effective Disease Management – A comprehensive EHR with chronic disease management modules electronically generates (1) disease registry to identify patients with chronic disease i.e. diabetes; (2) point-of-care provider alerts; (3) electronic forms for documentation of examinations; (4) patient report cards with individualized patient results based on a clinic encounter and (5) provider patient panel reports, enabling providers to track their performance compared with the aggregate performance with national benchmarks. Without an EHR system, effective and efficient disease management is just difficult or not possible at all.

  • Brian,
    Actually blogging wouldn’t be that terrible with Netscape. It’s other things that would be terrible with Netscape. The real difference though is the cost to get and implement an EMR versus install a web browser. There are 300+ EHR vendors, so it’s hard to paint as broad a stroke as you’re painting. However, testing all 300+ EHR vendors is a very expensive thing. It’s hard enough to try the 3 web browsers.

    Anthony,
    I should just repost that list every couple months. Although, it is a permanent page linked in the sidebar of EMR and HIPAA that lists those benefits: http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/

  • The other issue is if the doctor is retiring soon, then there is really no incentive at all to get MU certified. And the productivity drop seems accurate, although I’m on the implimentation side and not the user support side, our colleagues over there say that there is a signficant drop in productivity once they go live with our product (as expected), but – here is the kicker. At best it will get back to where it was before. No productivity improvement over paper, in other words, according to ancedotal information (with all of the implied caveats). Granted, MU is great for HIT, but for physicians? I’m not so convinced, being in the trenchs that I am. Every day there is some problem, minor or major. Every time the system is down leads to huge issues downstream (luckly for us that is quite rare). Still, practices would be well advised to have really strong recovery tools in place and a known procedure for disaster recovery (ie the server crashed).

  • @Anthony –

    Well summarized list of theoretical benefits. Unfortunately, as Brian commented, any of the EMRs I’ve seen that can accomplish all the items you list, are unflexible to the point of unusable. A doctor is a doctor first, with competing priorities (parent, spouse, business owner, etc….) and a technologist or super user capable of doing all that you list within the crop of poorly designed products available is a LONG ways down on that list.

    EMR always looks good on paper. But the real world stands in sharp contrast to the theoretical. Quite simply, if they were as good as stated, every doctor would have one already and there wouldn’t be billions of $$ of stimulus necessary.

    Compounding this are very large, and very valid studies with empircal and not subjective evidence:
    1. EMR utilization has ZERO impact on quality of care (University of Harvard and Stanford Departments of Public Health.)
    2. EMR may “significantly harm” an ambulatory practice (Congressional Budget Office)
    3. The UK recently abandoned it’s national effort at EMR after spending $$ BILLIONS!

    Here’s the issue: That which cannot be reliably duplicated (patient exams) cannot be reliably automated (delivery of medical care). Ask a physician how often two patients present in identical fashion and respond identically to identical treatment.

    The real issue is improving record keeping and automation to offset the fiscal challenges of running a practice. Good medical care can happen without a computer. It can’t happen without physician/patient trust. If a doctor has his/her hands on a computer and not on a patient – they are losing money and providing LESS care.

    My 2 cents after 13 years in working with practices (not hospitals).

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