Of Meaningful Use – I wouldn’t remove anything!

The following is a guest blog post by Joel Kanick 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?

Joel Kanick
Joel Kanick
President and CEO of Kanick And Company and Lead Developer and Chief Architect of interfaceMD

In fact, the pursuit of Meaningful Use (MU) certification has given our company many new ideas that allowed us to go above and beyond the bar MU already set.

Initially, doctors bought into EMRs for the financial incentive. Now that they are educated consumers, they want everything that was promised to them to work for them. Doctors have learned that EMRs are only one small part of the Healthcare Information Technology (HIT) puzzle. They need help putting the rest of the puzzle together.

No one is complaining about MU regarding the direction it is taking healthcare or HIT industries.

Any complaining that comes from a vendor is usually because their technology is outdated and behind the technology curve. They are angry because MU is calling them out. So, shame on vendors for becoming rich, fat and lazy, and not keeping with current technology.

Of the complaints I hear from providers, there are two scenarios:

First scenario: the providers who resent the government telling them how to practice medicine. However and upon deeper review, these providers already ask and track most of all these data points. They just don’t like the way it has been required and thus crammed into their current systems. I understand their anger, they were not consulted as to how to fit all this into their workflow and so it is cumbersome to use.

Second scenario, the providers’ office is still using fax machines, some required by their EMR vendor. They are still dictating (PCs, iPhone apps, phone recorders) all their exam data and still relying on paper charts. In practices of all sizes, providers complain of MU because they don’t want to change how they operate their business. After all, they have been doing it this way for many years, successfully. They complain of this change because they fear the unknown.

They are doctors; highly skilled and highly educated in medicine but not in business or technology. I see so many doctors closing their privately held medical practices to join a group practice or a hospital setting. Most will freely admit that it’s because they don’t want to address the fear and go through the anticipated pain of migrating to a paperless environment. They don’t know how to choose or maintain the system, with or without MU.

What I know MU is positively doing:

  • Setting a standard language (ie: XML)
  • Setting a standard format (ie: HL7)
  • Setting a secure communication channel (ie: Direct Protocol)
  • Requiring patient portals to potentially aid in convenience to the patient and lower the workload on office staff
  • Creating a standard method to share data electronically (ie: CCDA)
  • Demanding security and encryption and planning for emergency scenarios
  • Utilizing eRx to reduce fraud, abuse and increase safety in drugs that are prescribed
  • Reducing paperwork (eg: lab requests), speeding-up information delivery (eg: lab results electronically instead of by paper delivery)
  • Promoting communication to educate patients
  • Demanding reconciliation of data when exchanged between two organizations to make certain correct information is gained

Selfishly, from my point of view, the largest complaint regarding MU2 is that it requires all pertinent health information be exported and imported in a standard format allowing providers to easily change EMR vendors. This MU requirement should scare some EMR vendors!

Effectually, MU is pushing change and as a result it is getting a bad rap.

See other responses to this question here.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • I agree the data exchange changes forced by MU are long overdue and welcomed. However, I don’t think the government needs to be in the business of dictating UX, and other features that should be market driven. I would have preferred if the MU dollars went into a universal repository for exchange and retrieval of patient data. By operating and authenticating users for such a service as a federal entity we would have solved the many issues with duplicate tests, medical errors and have the ability to better mine our collective data. The bandwidth spent trying to interpret, implement and test-out the many arcane MU requirements could be better spent developing user centric and market driven features. Put another way, if you needed MU to show you the path to a better product then you have bigger problems then the debate over MU.

  • XML, HL7 and CCDA has a been around. Even with interchange requirements of MU, that barely limps along.

    eRx has/had been a separate program, so MU doesn’t really help that.

    Demanding security and encryption – already a HIPAA requirement.

    Even though this is already a HIPAA requirement, the “teeth” of HIPAA are not scary enough to docs, yet the “carrot” of cash-money prods many of them to do this…requirement, so I will say it has helped there.

    All of this goes back to the simple fact of: if an EHR really made an office more efficient, EHRs would have been in place years ago and there would be no need for the G to pay docs to push them in that direction.

  • John Brewer says:

    “If an EHR really made an office more efficient, EHRs would have been in place years ago and there would be no need for the G to pay docs to push them in that direction.”

    Government incentives and requirements have often been necessary to promote adoption of important and needed technology. Air bags, seat belts, dual braking systems would still be an extra cost option were it not for NTHSA, etc. Even something as simple such as safety caps on medicine bottles had to be mandated to get them used.

  • To imply that vendors dislike MU because they are behind the technology curve is a rather pompous statement. What some vendors dislike about MU has nothing to do with the required technology; it is the way items are implemented, the way certification is being performed, and the inefficiency that some of this forced implementation is creating. Dealing with ONC, who has been unresponsive when errors with the testing have been brought to their attention is frustrating to say the least. We have programmed things strictly to be certified – not because a provider wants them, or even needs them to meet MU – but because ONC says we have to.

  • I once took a look at a sample HL7 patient record in all its XML glory — what a convoluted mess. Some parts must have gone 20 levels deep and the content often bordered on irrelevance.

    In the engineering world, the KISS (Keep It Simple Stupid) principle is key to a product’s long-term success. And of course with the government guiding EMR’s standards, that can never happen. Top-down simply does not work well.

    In electronics, standards are set by the IEEE or ANSI organizations, to which all product developers contribute support and suggestions which go through an iterative review, and standards evolve to which all the companies agree to comply. To my knowledge, there is no such independent group for the EMR community.

  • David Swink,
    The standards go through a rule making process, but I don’t think the right people are getting involved in it. It’s too hard and many just haven’t committed the time. I think a comment in this guest blog post describes it well: https://www.healthcareittoday.com/2014/01/03/one-ehr-vendors-experience-with-meaningful-use-stage-2-certification/

    “You have to pass the legislation to know what’s in it.” Many EHR vendors didn’t know the details of MU until they started to implement it. Now that they’ve been through the implementation they could provide much better feedback on MU and the various standards.

  • @ Carl: My reference was to the efficiency, not safety. Few docs I talk to claim any efficiency increase from an EHR…a PM, yes, but not an EHR.
    Also, since because airbags, seatbelts, etc are required by law, this does not take away the fact that they still add to the cost – no, they are not now options, but we still pay more for cars with these requirements.

    @ Catherine: True!

    @ David: which version of HL7? It doesn’t matter, they are all a mess, but my point is, not all versions of HL7 are compatible as I found out a few years back trying to get two systems to talk with each other, that were using different versions of HL7.
    Aren’t standards great?

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