What If Meaningful Use Were Created by Doctors?

It’s safe to say that meaningful use is growing through its challenges right now. My post yesterday about killing meaningful use and the new Flex-IT Act should be illustration enough. While it’s easy to play Monday Morning Quarterback on meaningful use, I think it’s also valuable to consider what meaningful use could have been and then use that to consider how we can still get there from where we are today.

Many of you might have read my post on The Purpose of the EHR Incentive Program Accordign to CMS. CMS clearly stats that the purpose of the EHR incentive money and meaningful use is to move providers towards advanced use of health IT to:

  • Support Reductions in Cost
  • Increase Access
  • Improve Outcomes for Patients

This has very clearly been CMS’ goal and it’s reflected in what we now know today as meaningful use. Let’s think about those from a physician perspective.

Support Reductions in Cost – So, you’re going to pay me less for doing the same work?

Increase Access – So, you’re going to send me patients who can’t pay their bill? Or does this mean I have to do more work making my records accessible?

Improve Outcomes for Patients – Every doctor can support this. However, many are skeptical (with good reason) that the various elements of meaningful use really do improve outcomes for patients.

If I were to step back and think what a doctor might consider meaningful use of an EHR system, this might be what they’d list (in no particular order):

  • More Efficient
  • Improved Care
  • Increased Revenue

More Efficient – Will the technology help me see patients more efficiently? Will it allow me to spend more time with the patient?

Improved Care – Will the technology help me be a better doctor? Will the technology help me make better use of my time with the patient?

Increased Revenue – Will the technology help me get paid more? Will the technology lower the cost of my malpractice insurance and reduce that risk? Will the technology create new revenue streams beyond just churning patient visits?

I’m sure there are other things that could be listed as well, but I think the list is directionally accurate. When you look at these two lists, there’s very clearly a major disconnect between what end users want and what meaningful use requires. With a lot of the EHR incentive money already paid out, this divide has become a major issue.

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.

8 Comments

  • So from the perspective of the taxpayer (the one footing the bill after all).

    Obviously we can disregard “increased revenue” as something that is not going move the needle with the taxpayer.

    The taxpayer probably likes more efficient, but he or she has a different perspective on what efficient means. Efficient in the context of your bullet seems to more efficiently dealing with the patient and issue in front of the doctor today. While the taxpayer/patient is far more concerned with the totality of efficiency of the healthcare services they receive. So while it might be very inefficient for an individual doctor to write up a detailed referral today in a structured way. It is very efficient for the taxpayer if the when they go to the consult in two weeks, the visit doesn’t start with the specialist asking why are you here today.

    Improved care. The most aligned of all so think I will just leave that one be.

  • Travis,
    I should do a future post talking about what meaningful use would be from a patient perspective. Definitely adds in another layer to the discussion. I haven’t thought about it deeply yet, but my gut tells me that their version of meaningful use would be different than what meaningful use is today as well.

    Improved care is the one that’s most aligned. Maybe we should focus on it more.

  • There would be no need to force docs to go electronic IF EHRs showed and ROI.
    They don’t.
    Add to this, the ridiculous requirements of MU and you have our current mess.

  • Very interesting how you get different aims depending on what perspective you look at when it comes to EHRs.

    Clearly, CMS’s aims were not clearly aligned to how MU was implemented. I don’t see how getting physicians to get certified EHR’s improve access. I believe MU has had a direct impact in the further demoralization and fragmentation of primary care (just to pick one disaster). Not improving access will not improve outcomes. And how does a physician/medical group/hospital that foots a large bill to yearly licensing support for a certified EHR reduce cost? The cost burden will go somewhere else…taxpayers and patients (both the same).

    So, I guess I have to wonder who really came up with MU now that we “know” what CMS’s aims are for MU. Are we even on the same planet? Forget provider and patient aims (which I think ought be paramount here but was disregarded), we’ve got a huge disconnect here. Something, somehow went terribly wrong…

  • On point X 3 . CMS just wants to force doctors into meaningful use at the cost of 40 billion so they can have big data. It has nothing to do with MDs having a meaningful experience with an EMR. It does not address functionality of an EMR. A high cost for MDs with a negative ROI for $$ and time.

  • Gary,
    I think that maybe should have been a reason for CMS to do it, but there are a lot of reasons why I don’t think that was their reason to do it. First, Congress passed the law, not CMS. Second, the people I know at CMS that worked on the HITECH act were quite interested in the patient care side of things than they were trying to lower CMS’ costs. Next time I’m with them, I’ll have to talk with them about whether the discussion of CMS’ costs was even part of the regulatory decision making of meaningful use. My guess is that it wasn’t. Third, if they did MU to try and lower their costs, then why weren’t they ready for the data that MU produced?

    I do think there’s a disconnect between MU and the doctors and patients, but I don’t think it was because CMS was watching out for itself and wanted big data.

  • John,
    I agree and disagree with your statement, I am sure you are not surprised. I think there are two elements involved here, the MU guys (YOUR GUYS/GALS MENTIONED HERE), who say, hey lets try to inter-operate medical information, provide it to the community to reduce costs (Duplicate Tests, Errors due to unavailable Records, Errors due to illegible orders or scripts, etc…) and a whole other element who said, hey wait, we can use this to grab lots of data via PQRS and Regulatory for our Statisticians in the other group. To me these are two separate groups.

    From my perspective the issue is in the later, because A.) It does not directly correlate to better care (i.e. Cardiologist – How do you treat CAD and manage it, ok prove it and send us data or PCP – Do you take vitals for people with Hypertension, ok prove it and send us the data) and B.) It clouds completely the focus of the first group, it may seem simple in the beginning, but in the end nearly all of our development efforts, over 50% would be on all the Measures and moreover this focus on Development and Clinical Resources is clearly drowning out the more noble picture.

    I had this debate in Arizona in a packed house. I was a speaker and one of these Medicare Statistics People, a very nice looking very smart young lady stood up and argued these points with me. I remain sympathetic to her need to collect data for Government Statisticians but remain adamant that this has no bearing on patient care, unless the measures themselves are more meaningful.

    Further, the Government missed the mark hugely. They should have provided one National Patient Data Center that all EHR’s had to send data to, with one standard and one goal, national access to health records. This would have lowered development costs and made this a requirement on vendors, instead of just support a Standard for Communication with no standard on Cost and/or method for said communication (i.e. USA Clinical Portal). They have standards for storage method, storage communication but no storage location. In addition, on PQRS they really missed the mark. Why have Providers have to pay Registries or count on the EHR vendor as the registry to write all the complex algorithms/sql around creation of measures and output formated XML. Again, at a very low cost they could have built a engine on there side and said to the EHR Vendors, send us all this data and we will process it. That would also allow them to make changes without even involving vendors.

    I actually believe at some level they missed the mark on purpose just to overburden the industry, as the development requirements due to their lack of infrastructure is very high. I think they did not want to do the necessary back end infrastructure on there side to facilitate the MU Project.

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