Meaningful Purpose Phase I - Redux

Escher - Relativity, 1953

The world comments for the proposed rules for Meaningful Use Stage 2 are closing now. After reading Earth submissions of several organizations, I decided non to comment, since what I wanted to tell was covered past times much improve heeled organizations, as well as I am non convinced that individuals tin give the sack influence authorities inwards whatever shape or shape nowadays. Instead, I thought that this would hold out a adept fourth dimension to expect dorsum at Meaningful Use Stage 1 as well as regard if at that spot are whatever lessons to hold out learned, something that CMS did non deem necessary to do earlier moving upward the escalator to Stage 2. This is a fight peculiar considering that solely 5% of physicians were able to accomplish Meaningful Use thence far, as well as according to a novel study published inwards Health Affairs, less than 14% of physicians said that their EHR has all the bells as well as whistles necessary for Meaningful Use Stage 1. Since Meaningful Use Stage 2 is largely an amplified version of Stage 1, it may hold out useful to expect dorsum as well as position the most troublesome aspects, prior to significantly increasing their magnitude.

Computerized Physician Order Entry (CPOE) – On the surface, asking that 30% of prescriptions hold out entered inwards the EHR seems similar an almost trivial task. Where else would you lot acquire inwards them? H5N1 closer expect reveals that at that spot is some complexity inwards the Definition of the denominator for this measure, as well as the requirement is that 30% of patients who accept at to the lowest degree ane active medication on their medication listing should hold out prescribed at to the lowest degree ane item using CPOE. Does this hateful that the MD must prescribe something for a tertiary of patients seen? While this may brand feel for a principal attention MD with an elderly panel, it does non brand feel for other specialties, where patients accept most of their medications prescribed elsewhere. And the exclusion for those who write less than 100 scripts per reporting period, which is at nowadays ane total year, is non an adequate respond either. Perhaps a improve stair out would hold out to require a much higher per centum of all prescriptions written, to hold out entered through the CPOE module, regardless of whether the patients come upward inwards with existing meds or not. This is non an tardily thing to stair out though, but it could hold out done if EHRs were required to accept the prescriber identified inwards the medication list.

Clinical Summaries – Probably ane of the most confusing measures for both patients as well as physicians requires that 50% of patients hold out given a see summary inside iii days of the encounter. This is reasonable as well as fifty-fifty a fight lax if you lot accept at to the lowest degree 50% of patients using your patient portal. If not, as well as if you lot are really handing out printed summaries, the stair out makes piffling sense. First, the iii days menstruum is completely contrived. You either give people a summary when they walk out the door, or you lot don’t. How many patients do you lot know who volition render inwards the side past times side twosome of days to the constituent to pick upward their see summary? Or how many patients would hang around the constituent waiting a twosome of hours to acquire that summary? Zero. You either impress the thing out earlier patients banking venture lucifer out, or the patient volition leave of absence without it. Printing summaries at the goal of the see agency that all components accept been updated inwards the EHR during the visit. If you lot silent dictate most of your note, or if you lot goal notes at the goal of the day, or betwixt patients, your summaries may non hold out accurate. The 2d occupation with this stair out is that non all patients desire a summary, but Meaningful Use is non making whatever allowances for patient preferences. So what do people do? They either impress all summaries on newspaper as well as shred the ones left behind, or impress them to electronic file (to trigger the EHR count) as well as solely generate newspaper if the patient wants a summary. H5N1 much to a greater extent than realistic stair out would require that summaries hold out given to 100% of patients who asking ane during the see as well as 100% of summaries are made available on the portal inside 48 hours of the encounter. Click fewer boxes, kill fewer trees.

Electronic Copy of Medical Records – This most peculiar stair out requires that one-half of all patients requesting medical records are accommodated inside four occupation concern days. Why solely half? HIPAA guarantees the correct of all patients to obtain copies of their medical records. Meaningful Use requires an electronic option. If the EHR is capable of packaging a nautical chart inwards electronic format, why would you lot solely give a re-create to one-half of the people who desire it? How does CMS know who wants a re-create of their records? There is a checkbox of course, as well as if there’s that checkbox, as well as if you lot clicked it, chances are real adept that you lot volition also click the push clitoris to generate a nautical chart export, which should give you lot a perfect 100% score, which should accept been a requirement to encounter this measure.

Public Health Reporting – There are 2 world wellness measures to pick out from inwards Stage 1, immunizations information as well as syndromic data, as well as solely a evidence of capability was required, fifty-fifty a failed evidence was but fine. Should accept been a slam-dunk, but it was not. Most world wellness entities were non ready to have electronic information as well as most certified EHRs were incapable of transmitting anything inwards spite of beingness certified to that capability. I accept no suggestions for how to improve these measures other than refraining from requiring nonexistent things as well as ensuring that EHR certification is slightly to a greater extent than than fee-for-rubber-stamping.

Medications Reconciliation – This activity is required to occur for 50% of attention transitions. Since certified EHRs are non required to render truthful electronic reconciliation of 2 datasets as well as since ane almost never has a structured 2d medication listing from an exterior source, the best instance scenario consists of clicking on 2 boxes – ane at the front end desk, designating the see every bit a “transition of care”, as well as ane during the visit, validating that the physician (or assistant) opened the medication listing page. This stair out should accept been postponed until the mightiness to measure, as well as the tools to really perform reconciliation, decease available.

Security Risk Review – Nobody knows what that is. It is, however, a wonderful chance for information technology guys to preserve pocket-size practices of anything betwixt $2,000 as well as $5,000, as well as suggest that the server should reside inwards a cabinet as well as that the virus protection software should hold out updated. Why is CMS getting itself involved with HIPAA as well as safety is a mystery to me, considering that these things are nether the purview of the Office of Civil Rights (OCR), which is actively pursuing the thing independently of Meaningful Use. This stair out should non accept existed.

Clinical Quality Measures – Much has been written close the inadequacy of the chosen character measures for anything but principal care. Also the seemingly multiple choices of measures are largely theoretical because certified EHRs are non required to certify for all measures as well as users are basically stuck with whatever the EHR vendor chose to certify, whether the certified measures are applicable to the exercise or not. For example, ane real pop EHR solely has diabetic bill of fare measures available. If you lot are, say, a dermatologist, you lot volition accept to study weight administration every bit constituent of the heart as well as also dismal measures for your ongoing administration of HbA1c. The other major occupation with clinical character measures is their hidden complexity as well as the non straight off obvious information elements required to calculate the stair out as well as peculiarly the exclusion of patients from a given measure. H5N1 real interesting illustration of how some EHRs bargain with such complexity is the novel as well as fairly mutual checkbox side past times side to whatever given diagnosis to grade the status every bit concluding inwards less than vi months, since this is an exclusion to the weight administration heart measure. Seriously? And this should hold out made available on the patient portal too? Clinical character measures should hold out carefully reconsidered as well as dialed dorsum to a sensible laid that is genuinely meaningful.

Meaningful Use Stage 1 created a lot of confusion with providers trying inwards earnest to encounter the measures as well as gobbled upward scarce resources inwards organizations large as well as small. Many of the measures are beingness attested to with real piffling confidence inwards accuracy, Definition as well as meaningfulness. It would accept in all likelihood been a real adept thought for CMS to decease out at that spot as well as survey its existing as well as potential meaningful users to seek some authentic guidance, instead of relying on professional person advocates (and occasional testimony from carefully selected users), earlier putting inwards house the side past times side theoretical pace on the at nowadays famous escalator.