July 17, 2013|Categories: Meaningful Use
Here’s a basic reality about Meaningful Use that may be often overlooked: If medical practices and health care IT vendors focus on using technology to facilitate the process of good patient care, then Meaningful Use is easily achieved. If the focus is only on meeting guidelines, then good care does not necessarily follow.
In my opinion, Stage 1 Meaningful Use has initiated the exercise of digitizing a workflow process. The 10 core components cover basic elements that all providers regularly capture about patients, or create and use through the process: Demographics, a problem list, a medication list, allergies, a smoking history and vitals have always been captured, and the process is part of history-taking curriculum in medical schools. The only real difference now is that we have to show we can do it digitally.
Some electronic medical records (EMRs) put the onus on physicians to perform this digital transformation. However, in more efficient offices, the information physicians previously collected is now captured by staff. Physicians are tasked with verifying the accuracy of the data rather than entering it.
Stage 1 measures have also encouraged the digitization of the information utilization process. Previously, drug-to-drug and drug-to-allergy interactions were taught and memorized by the physicians; now, as a result of Meaningful Use requirements, we can access an automated and regularly updated database with cross-reference options, a huge value add and time saver.
The process of effectively utilizing health information at the point of care is more challenging as physicians must document their thoughts and propagate the plan by way of e-prescribing and/or a Computerized Physician Order Entry, and by creating a clinical summary of care and making it available to the patient. This requires effective, on-the-fly documentation.
Our neurology office has been electronic since 2006 and, with a combination of manual data abstraction, the use of a tablet, plus write-to-text and voice-to-text technologies, we are reasonably successful at documentation. However, not all practices can say the same—adding technologies to a dysfunctional process, more times than not, can lead to a faster dysfunctional process.
One office I am familiar with provides a perfect example: Since going digital, they dictate and transcribe into a Word document they then need to attach to the patient file. Faxes in their office are printed, scanned, and manually attached to the EMR; then, the paper fax is shredded. Instead of decreasing the number of tasks, added technology has increased the amount of work.
As of early 2012, only 9.8% of physicians were meeting some of the previously mentioned Stage 1 standards, according to a recent survey on EMR use. Yet, in my opinion, Stage 1 guidelines have not been difficult to achieve. Meaningful Use is easy (so far). For example, the patient smokes. Done. Stage 1 checked off successfully.
But using information meaningfully is harder. The patient smokes. The patient is provided with smoking cessation education, is enrolled in a smoking cessation program, receives various treatment options, and is called, text, or e-mailed a follow up. Patient demonstrates reduction and cessation of smoking. This is an example of information meaningfully used.
Stage 2 Meaningful Use should move us slowly towards actually using health information technologies meaningfully, via clinical quality measures and the coordination of care between providers. My office and I aren’t really concerned with the requirements of Stage 2—using information meaningfully has been a by-product of an efficient, patient-centric practice.
But Stage 1 and Stage 2 offer inadequate expectations of what technology should do for health care. Though I have successfully adopted an EMR and have attested to Meaningful Use, I feel the pain and fear of other practices who are still on paper records, have not found a suitable technology solution, or resist the change in office efficiencies. I appreciate, to some degree, the truth in their statements, which I often hear in conversations with colleagues: “Why use technologies that slow me down?” Keep asking that question, I tell them. Technology can and will improve your ability to care for your patients when the software vendors deliver the tool and the expertise we need to use technology meaningfully. So we need to keep demanding better solutions from the industry and continue to ask these types of questions. Meaningful Use will not be achieved until physicians are able to meaningfully use health information technology at the point of care.
Dr. Gee is an athenahealth client specializing in neurology at Frontier Neurosciences, based in Cody, Wyoming.