Meaningful Use includes the creation and transmission of patient registries for reporting various medical data such as vaccinations, medications, lab results and vital signs including weight, body mass index (BMI) and blood pressure. To be honest, I don’t know any real practicing doctors out there who worry about their EHR’s ability to perform registry generation, but non-doctors with more time on their hands seem to think it’s the Holy Grail. As it turns out, a recent post by Ken Terry EHRs Give Docs Analytics Tools They May Ignore sparked my interest.
It was pretty intriguing that an insurance company like Blue Cross Blue Shield would be sponsoring a pilot experiment to correlate doctors’ access to EMR and EHR technology with doctors’ ability to generate patient registries. Clearly, this is the first step in making searchable databases that will enable users to ask more detailed questions. Since the pilot study was not clear on what or how much information was shared with the insurance company by the administrating body for the study, the Massachusetts eHealth Collaborative, there’s an interesting closed door there that the public can’t see behind right now. Why does an insurance company want such information? Let’s be honest: it’s got to be money, plain and simple. Insurance companies are for-profit entities after all. Assigning report cards and pay-grades to doctors based on performance? Stratifying out “good” and “bad” doctors? Door #3? If they just want to study problem areas for public health improvement, then it would be preferable to define their end goals publicly ahead of time — which has been one of my big beefs with Meaningful Use.
I loved the comment by Jane Metzger, a CSC consultant who is an expert in registries. “Most of today’s EHRs can do a registry-like function, but it takes work to do that… Not every practice that adopts an EHR is committed to care management–having guidelines for care, knowing who your diabetic patients are, and deciding you should see them at least once a year and so forth.” Wow — what a negative connotation of docs who might have other ways to benefit their patients. However, Metzger did mention something I agree with in the end: ” it’s extra work to do it.”
Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009. He can be reached at doctorwestindc@gmail.com.
As the article states, simply enabling a registry within an EMR for primary care physicians living in the hamster in the wheel world of fee for service will not get us to the proactive quality measures that meaningful use or any other program is going after. Providing physicians with a registry that is designed for a care coordinator to use could do that. This is a resource funded through alternative payments available within the medical home payment model. It is important to look at these registries beyond information available within the practice, capturing data from as many sources as possible so that treatments for patients with chronic conditions can be taken into account as patients traverse the healthcare system. This gives the care coordinator the information they need to look at the patient panel holistically and focus on those patients that are most at financially or clinically at risk. I do understand Dr. West’s concern that the focus of the health plan is not often altruistic but we must understand that many of them are just trying to setup a system where they can be positioned as an enabler of models like patient centered medical homes as well. The potential medical savings to the health plan in that model does position them to be more competitive as the insurance exchanges become a reality (or not) in 2014 – and providing their medical homes with a registry is a step they can take toward doing that. Bottom line is that payments and workflow models within the practice have to align with systems to bring us the holy grail – one without the other will not work.