Tuesday, June 4, 2013

The Meaning of “Meaningful Use” of Electronic Health Records
“When I use a word, “Humpty Dumpty said, in rather a scornful tone, “It means just what I choose it to mean – neither more or less.”
“The question is,” said Alice, “whether you can make words mean so many different things.”
“The question is,“ said Humpty Dumpty, “which is to be the master- that’s all.”
 Lewis Carroll (1832-1898), Through  the Looking Glass
My least favorite word is “meaningful.”  Supposedly it means “full of meaning.”  But those who use it tend to be full of themselves, thinking only they know what is full of meaning.
A good example is the use of “meaningful use” for electronic health records in the American Recovery and Reinvestment Act of 2009.  The Act contained a passage offering incentives ($44,000 to $64,000 per physician and $11 million for per hospital) who demonstrated “meaningful use” of electronic health technologies.
When pressed for what “meaningful use” meant,  CMS  came up with this explanation:
(1) ”Demonstrates use of certified EHR technology in a meaningful manner;

(2) demonstrates to the satisfaction of the Secretary that certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care such as promoting care coordination, in accordance with all laws and standards applicable to the exchange of information; and

(3) using its certified EHR technology, submits to the Secretary, in a form and manner specified by the Secretary, information on clinical quality measures and other measures specified by the Secretary.”

Well, that clears things up.
To make a short story long,  CMS has since come up with 24 “meaningful use” criteria that must be met, in stages, before one qualifies for federal subsidies.  
Is it any wonder that only 10% of physicians and hospitals have the time or money  to meet these criteria – which someone described as  a bureaucratic blizzard?  The wonder is that somehow government has managed spend $15 billion for those who did.  The other wonder is that to date,   most EHRs meeting these criteria are expensive to install and  to maintain, and are  usually unhelpful in clinical situations. As a physician told me, “Look, I was trained to practice medicine,  not to be a computer expert, not to be a data entry clerk,  not to collect data for the government, which will be used to judge me.”
The consequences of the 2009 stimulus act are predictable, as evidenced by this article from Kaiser Health News. Despite noble intentions and the burning belief that data, spread sheets,  and clinical algorithms will be guides for the best care,   government is not yet the master of physicians or of their practices
Docs Fall Short Of Meeting Standards In Government  Push For Electronic Health Records

New research shows that most physicians are not meeting the federal "meaningful use" criteria for electronic health records.

Bloomberg: Most Doctors Don't Meet U.S. Push For Electronic Records.
Fewer than 1 in 10 doctors used electronic records last year to U.S. standards, according to a survey that shows the challenge facing a multibillion-dollar effort to digitize the health system for improved patient care. Only 9.8 percent of 1,820 primary-care and specialty doctors said they had electronic systems that met U.S. rules for "meaningful use," a list of tasks such as tracking referrals or filling prescriptions online (Nussbaum, 6/4).
Medscape: Few Physicians Meet Meaningful Use Criteria For EHR

By early 2012, few physicians had met meaningful use criteria for electronic health records (EHRs), according to a survey study by Catherine M. DesRoches, Dr PH, from Mathematica Policy Research, Cambridge, Massachusetts, and colleagues, published online June 3 in the Annals of Internal Medicine. Furthermore, those who did meet criteria had difficulty using computerized systems for panel management tasks (Barclay, 6/3).
Also in the news --
Marketplace: A Health Datapalooza: Washington And Private Health Care’s Quest To Mine Health Data
We’ve all heard of the summer rock festival Lollapalooza. But how about Health Datapalooza? For two days this week, nearly 2,000 data geeks, entrepreneurs, federal bureaucrats and medical folks will descend on Washington, D.C., hoping to help solve the nation’s healthcare crisis through algorithms and spreadsheets. The health data industry has been called a "health care Silicon Valley" -- an explosion of firms looking for gold in mountains of medical information (Gorenstein, 6/3).
Tweet:  Four years after CMS offered physicians financial incentives to meet “meaningful use” criteria for EHRs,  less than 10% meet these criteria

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