Monday, November 30, 2015

Physicians Rise in Unison Against “Meaningful Use” of Stage 2 and Stage 3EHR Mandates

Meaningful use (MU) is a health information technology context (HIT) defines U.S. government standards for Electronic Health Records (EHRs) for exchanging patient clinical data between physicians, between physicians and providers, and between physicians and patients.

Among physicians, there is a united movement to resist government interventions that create loss of physician autonomy, interference into physician-patient relations, mandated “Meaningful Use” of EHRs, and increased burdensome certification of doctors.

This movement took a tangible step forward in July 2014 when a large number of physician organizations and leaders held a physician summit, under the banner of United Physicians and Surgeons, in Keystone Colorado.

It took another giant step forward recently when 111 physicians organizations sent a letter to the AMA asking for a redesign of Stage 2 of the Meaningful Use EHR criteria with a delay of Stage 3 extension of those criteria.

The Three Stages

Stage 1, starting in 2010, was for CMS to promote EHR use. That stage succeeded, and some 80% of physicians now have EHRs in one form or another.

Stage 2, in 2012, was to increase EHR compliance to introduce clinical decision support and care –coordination and patient engagement, requirements .

Stage 3, from 2014 to 2016 was to make exchange more “meaningful” by punishing physicians financially for skipping Meaningful Use, and if by 2018, physicians did not comply by cutting reimbursement 1% a year up to a maximum of 5%.

Steps in Stage 2

Stage 2, for those of you not in the know, has six steps.

1) Use computer entry data order entry for medications, lab and radiology results.

2) Generate and transmit prescriptions electronically.

3) Use clinical support support to improve performance in high-priority health conditions.

4) Provide patients the ability to view online, download and transmit health information.

5) Incorporate clinical lab test results into certified EHR technologies.

6) Use secure electronic messaging to communicate with patients .

Clinical Burdens of Meaningful Use

All of these tasks require data entry for clinicians, hiring more personnel to enter data, time spent away from patients , and explaining to patients what Meaningful Use is all about.

In general, most physicians have accepted Stage 1 but not Stage 2 and 3. Physicians have rebelled against Meaningful Use in those two stages. Physicians agree that MU does not increase quality or improve care, requires unnecessary busywork, is overly expensive, and distracts from patient care.

In short, physicians across America in 111 physicians organizations have declared Meaningful Use of EHRs, in its Stages 2 and 3, to be a bloated $30 billion bureaucrat boondoggle, or boongoogle, if you're into word play, that converts physicians into electronic serfs for the government. The road to serfdom is electronic.

25 Reasons to Kill Stage 2 and Stage 3 Meaningful Use

In a biting commentary in the November 28 Health Care blog, Hayward Zwelinger, MD, gives 25 reasons that the time has come to kill Meaningful Use of EHRs.

1. The majority of physicians already use EHR and there is no reason to continue to incentivize them.

2. There is a ground swell of discontent among physicians arising from the poor design of many Certified EHRs and the current MU program further enshrines the use of these EHRs.

3. Many physicians believe that MU program interferes with the physician-patient relationship by forcing physicians to spend time acknowledging clinically meaningless Certified EHR prompts.

4. Hospital resources devoted to meeting MU requirements have hindered some hospital’s ability to update their IT infrastructure by drawing resources away from important IT problems.

5. MU mandates have onerously consumed EHR vendor and healthcare provider resources while decreasing resources which can be devoted to creating innovative healthcare solutions.

6. Physicians do not believe (nor is there data to demonstrate) that forcing patients to visit the physician’s MU mandated patient portal promotes the health of their patients.

7. Physician practices are overburdened with bureaucratic mandates (Rx appeals, insurance requests for records) and MU tasks consume staff and physician time, thus diverting them from patient care.

8. There are substantial financial penalties and psychological costs which physicians will incur if they are audited as a result of their participation in the MU program and these financial penalties are disproportionate to the financial incentives arising from the MU program.

9. Only 12% of physicians have completed MU stage 2 and fewer will likely participate in MU3.

10. The collective burden of all the workflow changes required by three stages of Meaningful Use regulations will make it hard for clinicians to spend adequate time on direct patient care (John Halamka, M.D.,

11. The public health reporting requirements required by MU will be hard to achieve in many locations due to the heterogeneity of local public health capabilities (John Halamka, M.D.)

12. There is no data which proves that achieving MU Stage 1 or Stage 2 improves the quality or reduces the cost of healthcare

13. A majority (68%) of physicians report MU measures do not help them improve patient care or safety. (Survey of Texas Physicians Meaningful Use. Texas Medical Association)

14. A decision to work towards a “delay” in MU Stage 3 program will enshrine the currently intrusive and wasteful MU1 and MU2 work protocols as part of the standard office visit.

15. While there is great promise which may derive from true HIT interoperability, there are many ways to achieve HIT interoperability independently of the MU

16. It is illogical to hold physicians responsible for implementing HIT mandates which are clearly beyond their ability to create, pay for and/or implement

17. Meaningful use has ” created … a monster, when really what we were shooting for was good patient care.” (Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems and Health Policy. The RAND Corporation, American Medical Association 2013)

18. Reducing the cumulative burden of rules and regulations may enhance physicians’ ability to focus on patient care. (Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems and Health Policy)

19. The current approach to automated quality reporting does not yet deliver on the promise of feasibility, validity and reliability of measures or the reduction in reporting burden placed on hospitals. (A Study Of The Impact Of Meaningful Use Clinical Quality Measures. Floyd Eisenberg,Caterina Lasome, Aneel Advani, Rute Martins, Patricia A. Craig, Sharon Sprenger. 2013)

20. The workflow changes to meet the MU eCQM reporting tool requirements have added to physician and nursing workload, providing no perceived benefit to patient care. (A Study Of The Impact Of Meaningful Use Clinical Quality Measures. Eisenberg et al)

21. EHRs are not designed to capture and enable re-use of information captured during the course of care for later eCQM reporting. (A Study Of The Impact Of Meaningful Use Clinical Quality Measures. Eisenberg et al)
22. Champions of EHR adoption within hospitals ….
have been significantly challenged by Meaningful Use Program eCQMs that are complex, inaccurate, outdated and that require incredible detail to be documented (often in duplicative ways) in a structured form in the EHR with no perceived additional value to patient care. (A Study Of The Impact Of Meaningful Use Clinical Quality Measures. Eisenberg et al)

23. Fifty two percent of Texas physicians report all or most of the (MU) measures are not meaningful to care. (Survey of Texas Physicians Meaningful Use. Texas Medical Association)

24. There is essentially no data which demonstrate that the vast majority of meaningful use measures (excluding clinical decision support and computerized provider order entry) improve the quality of patient care. (Ann Intern Med. 2014;160:48-54)

25. The existing MU program has had adeleterious effect on physician morale. (Robert Wachter, The Digital Doctor: Hope, Hype Harm at the Dawn of Medicine’s Computer Age)

A Closing Note

In closing, a personal note. I am suspicious of the use of the word "meaningful." "Meaningful", in my experience, is invariably condescending. Condescending deployment of "Meaningful Use" in Stages 2 and 3 has reached the limits of clinical usefulness, practical operability, and physician-patient intervention.

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