If Meaningful Use Were Gone – Perspective from EHR Executive at Modernizing Medicine

The following is a guest blog post by Michael Sherling, MD, in response to the question I posed in my “State of the Meaningful Use” call to action.

If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?

Michael Sherling
Michael Sherling, MD, MBA
Chief Medical Officer and Co-Founder, Modernizing Medicine

What a great question! As both the co-founder of Modernizing Medicine, and a practicing dermatologist that uses EMA, I can appreciate the amount of time and effort it goes into developing MU feature sets, as well as inputting the data in to be a “meaningful user.”

The Top 3 Measures I would remove

  1. Clinical Summaries Provided to Patient
  2. Vital Signs
  3. Clinical Quality Measures

I understand the intent for patients to receive clinical summaries of each visit- but this places an incredible burden on the end user (physicians and office staff) to make sure that each patient has access to their clinical summaries.  For instance, even though we live in the digital age, several of my older patients don’t own a computer or have access to one.  Additionally, these summaries lead to more questions by the patients after the visit has been concluded often times regarding details of the summary that are relatively innocuous.

I have a serious beef with government mandating of Vital Signs.  Health care providers know when it is medically necessary to take vital signs and when it is not.  Those who never take vital signs, because it is unrelated to their scope of practice can claim exceptions, but those who take a few are often stuck between their medical responsibilities and getting an incentive.  In the end, these dermatologists and ophthalmologists wind up taking more blood pressures or measuring the height and weight of their patients unnecessarily to achieve the incentive.  This paradoxically is medically meaningless since dermatologists don’t treat blood pressure, and ophthalmologists don’t often dose weight-based drugs (they like eye drops).

Clinical Quality Measures needs to be renamed to Cost Effective Measures.   Clearly, the goal of CQM is to change physician behavior so that physician decisions are more cost effective.  This is needed in our health care system.  What today is an incentive based on pay for reporting, will be transformed to pay for performance tomorrow.  My concern as a physician is how do we know these are the right questions to ask?  If physicians comply with these CQM guidelines, will that result in not just lower costs, but more effective care?  I’d much rather see benchmarking around actual patient clinical outcomes themselves, using tools like static global assessments of disease rather than a questionnaire about whether or not I followed a recipe for how a committee thinks I should treat every patient with condition Y.

The Top 5 Measures I would Keep

  1. Electronic Prescribing
  2. Medication List
  3. Allergy List
  4. Drug-Drug, Drug-Allergy Interaction Checks
  5. Patient Search

All of these measures are critical to patient care and have obvious benefits.  With electronic prescribing, prescription orders are standardized and LEGIBLE! No need for the pharmacist to discern my own poor doctor handwriting anymore.   Keeping the medication and allergy lists updated and the drug-drug and drug-allergy checks enabled makes for great patient care.  No physician wants to prescribe a medication that interacts with another in a negative way, nor do we want to prescribe a medication that could potentially cross-react with a known allergy. Finally, patient search is a really cool feature that allows all of us to search for patients with specific diseases and medications. This is an important first step in getting records to behave more like research databases for clinical studies and less like word-processors for just note taking.

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  • I disagree with Dr. Sherling on the issue of vital signs. Many disease states can be first seen by using a watch, a stethoscope, and a blood pressure cuff. Hypertension, hypotension, tachycardia, bradycardia, heart sounds, irregular heart rates and more can be determined just by taking vital signs. Many people do not have regular check-up’s so catching these early warning signs in an office that the patient may think is more important for them to go to, like a dermatologist’s office, may be some of the only opportunities to catch them. Add in the ability to trend data over multiple office visits with multiple specialities make capturing this data even more important.

  • I enjoy articles such as this in order to consider all sides of important issues. The process of implementing a new process always starts off with what initially seems like a good idea however, as time goes on the reality shows that changes are necessary. It is critical to voice your opinions and hhs.gov lists all proposed regulations which are open for public comment. http://www.hhs.gov/regulations/

    In regards to MU requirements, it is important for all healthcare providers to review the MU guidelines regularly for revisions and newly updated definitions.

    I am sharing the following from healthit.gov,: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8_Record_Vital_Signs.pdf

    (Clicking on number 8 provides the full definition of Core Measure 8 of the 14 Eligible Professional Core Measures)

    New Exclusion (Optional 2013; Replaces exclusion above in 2014):
    Any EP who
    1. Sees no patients 3 years or older is excluded from recording blood pressure;

    1. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them;

    1. Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or

    4. Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.

  • Heidi,
    Glad you like these types of posts. That’s the goal of what we’re trying to accomplish. We want to get as much feedback as possible from as many people as we can get involved. Hopefully many will participate since it’s clear that many didn’t participate in the CMS open comment period. It was too cumbersome for most.

  • Patients on average forget about 80% of what they are told at their doctors office and after visit summaries are a huge patient satisfier.

    There is no requirement that they only be in electronic form and the standard at places like Group Health Cooperative (1000 providers and over 620,000 members) is to print it out so they take it with them. Many bring it back to their next visit and share it with family members.

    For those few doctors who are still practicing episodic care (like a specialist might) or who haven’t shifted to a more collaborative model of patient engagement it might seem like it is cutting into your revenue though.

    When however you put the patients needs at the center it is natural to do them.

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