Tuesday, April 21, 2015

The Failings Of Meaningful Use

It is remarkable that a program aimed at specific end users continues despite the fact the majority of those end users refuse to comply, even despite financial penalties from CMS.
By Linda M. Girgis, MD, FAAFP
"The intent of the meaningful use (MU) program, signed into law as the HITECH Act in 2009, was commendable, but its implementation has been wrought with delays and failures. While many doctors successfully attested for Stage 1, SERMO – an online community exclusive to physicians – is reporting 55 percent of the 2,000 doctors it recently polled said they will not be attesting for Stage 2 this year."

Meaningful use was proposed by HHS at the beginning of the HIT initiative.  It has nothing to do with the  meaningful uses of EHRs.  Meaningful use has to do with the use of the  data by second parties, mostly HHS and CMS.  Designed initially to be implemented in three stages, the first two have been implemented already. Those who did not or could not comply by October 2015 now face a penalty and reduction in payments from CMS (Medicare).  Stage I was not too difficult, Stage II was more onerous, and most of those who did not attest to Stage II  have indicated they will not attest to Stage III .  Many of these requirements are expensive and require extensive software patches or complete replacement of functional EHRs that have not passed their usable lifetime, nor earned their full deductibility according to IRS tax codes.  In fact many medical practices no longer host their own EHR and now lease cloud based EHR applications, where the upgrade is accomplished by the EHR host.  In fact this open up the possibility of cyber-threats.  The same may be said of Health Data Exchanges.
Many in healthcare question the sustainability of this program. While its noble goals are recognized, it has had a detrimental effect on doctors in private and small practices with both the cost and time required to implement it simply too much. Even hospitals and large systems struggle to realign their infrastructures to comply.
These failings are trickling down to patients resulting in less than desirable outcomes. Many doctors are choosing to drop Medicare rather than be penalized for something they don’t agree with. What I see as the biggest failure of MU, however, is the fact that its implementation was enforced before its feasibility addressed. How can MU succeed when the majority of doctors reject it?

Another failure of MU is it doesn’t properly address interoperability. One of the goals of the program was to have systems which communicate with each other, but this simply has not happened on a large enough scale. And it never will as there are too many systems and vendors who do not want to work with each other to build interfaces, they want to sell their own products.
In my practice our proposed interfaces failed to materialize because our vendors could not work with each other and rather than fix the problem, they pointed fingers at each other and tried to sell us their product. For example, it took 18 months to get our patient portal active and that only happened after we changed web hosts. Despite this, we are still not interfaced with our local hospitals and their vendors solution was for us to purchase the hospitals’ software. This, however, is not an option as we are affiliated with three hospitals which do not use the same system.

Many blame EHRs for slowing providers down and taking time away from the patient. However, it is not the EHR doing this but rather the metric reporting which is now required. Much of this reporting has nothing to do with patient care or a particular visit. For example, we are asked to record our patients email addresses and some don’t want to share this information. There is no option for this and, as a result, is picked up as a failure on our part. Is an email address really meaningful to a patient’s medical care?
The failures of the MU program are myriad, and not just on a small scale. It deselects, by its intrinsic workability, doctors in small and private practices. It cannot continue without fixing the inherit failures in the ability to carry out the requirements.  For me, I am attesting for Stage 2 because I have been using EHRs for 10 years and believe there is great value in digital data. However, I hope the technology and implementation catch up to the spirit of what it was intended to achieve.
About The Author
Linda Girgis, MD, FAAFP, is a board certified family doctor with Girgis Family Practice. Dr. Girgis studied medicine at St. George's University School of Medicine and served her residency at Sacred Heart Hospital in Allentown, PA.

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