Home Forums Discussions General Discussion Meaningful Use According to David Blumenthal

http://healthcarereform.nejm.org/?p=3732&query=OF

I know you all aren't watching this very closely, but if you haven't seen it David Blumenthal wrote a Summary Overview of Meaningful Use Objectives you might be interested in looking over; it seems it's done. I haven't found a good discussion of this by someone who follows this closely yet. (Can you tell I distrust actual journalists will tell me something useful?)

The actual size of the meaningful use bible is 864 pages now. It was written by a group of EMR vendors headed by John Glaser (http://histalk2.com/). To try to get the $44000.00 you need to satisfy each and every criteria 100%. Your losses in productivity and in the reporting process will be massive. Good luck to anyone that tries it. You can count me out. When the penalties begin to fly, I'll be out of Medicare altogether.

My only worry is that MU will mutate and be adopted by private insurance companies. At that point you'll see small physician offices fold and doctors in general will become employees of massive group practices. Healthcare will be truly changed forever...

Once again, I find myself agreeing with Al, who has always been right on the money when it comes to government and healthcare. I have read the NEJM article and read word by word the "Core Set" of objectives which must be met in order to qualify for the $44,00 for Medicare and $60,000 plus for Medicaid.

I too see little chance to be able to comply with these guidelines, which are not only impractical but I would find them extremely difficult to remember.

From looking at these core objectives, it seems obvious to me that before EMRs, doctors who were forced to actually take care of patients using pen and paper were not practicing medicine in a way that was meaningful. It is also ironic that while only a small percentage of us made the decision to obtain EMRs to improve our practices and patient care over ten years ago. Now the government is not only going to mandate that the 80% + who were too technophobic or had other reasons to not move to EMRs and are now going kicking and screaming, but they will at the same time not applaud those who were early adopters but punish them. While it was impossible to assess fully the outcome of the use of our endeavor via structured data, we were still light years ahead of our colleagues when it came to organize care through the electronic implementation of patient visits and documentation.

I, for one, am apalled at seeing the government once again coming very late to the party only to try to act like they are the ones coming up with this concept. The change from the original rules secondary to the more than 2,000 written objections to two sets of rules involving a set of core objectives which must be met along with an ala carte group of rules that each doctor can decide him or herself which ones they wish to implement. If you look at the overwhelming and daunting list of objectives that are not only impossible to comply with but are nearly impossible to remember, the $44,000 seems it will find its way back to the bailing out of big business whose only core objectives seem to meet all the criteria of mismanagement of their business.

The article by Mr. Tuttle on the 11 things needed in order to design the perfect medical record system, if looked at in a different light, seems to have already been done via the laws of the market place. While EMRs have come and gone, EMRs like Amazing Charts have fluorished simply because they meet almost all of the criteria that he states. Most of his suggestions revolve around the ease of use and a doctor's ability to easily see and assess data. Therefore, the rapid adoption of an EMR, especially after the average consumer of these, has already demoed an average of five to ten other systems seems to indicate that AC meets those requirements and more.

The irony is that for an EMR to meet his standards while at the same time have the capability of recording over 50% of 13 year old's lack of trying cigarettes in structured data is almost mutually exclusive. I ask about cigarettes, alcohol and other illicit drugs of every patient over 12 and recording that I have done this, while helpful for the infamous medicolegal reason, does nothing for me to help patient care. And, whether or not my labs are faxed to me, and I sign them off after reviewing them thoroughly versus having them entered directly into AC in structured format doesn't change my care. And, I keep track of my immunization rates just as well using my programs rather than the states IMMPACT program, which is cumbersome and slower than hell.

No, I am beginning to realize -- no have already come to the conclusion -- that I will never be entitled to the money, even though I practice what I think is good medicine. Jon has given us all the tools we need to see patients in a way that meets their needs. Now, the government needs to just step aside and let us do our jobs. We do them for our patients, because our patients want nothing less. And, while drug interactions and allergy monitoring is a potentially life-saving addition, many of us already use 3rd party applications such as Lexi-Comp, ePocrates, eMedicine, UpToDate and Isabel.

I really had to laught when one of Mr. Tuttles 11 recommendations for the perfect EMR was that the software should be useable in a way that replicates software that the user is already familiar with. How can one possibly know what software they should have been familiar with prior to looking at EMRs?

No, it is unattainable for me, and I am going to just keep doing what I have always done. Open Amazing Charts, watch it connect to SQL Server, read the funny quote of the day (we need more Jon) and then practice what I consider good medicine.

Count me out. And, what would happen if physicians simply refuse to comply? I cannot be much more penalized for seeing Medicare patients than I am alread. And I, like Al, will simply stop seeing them. Then I will stop taking commercials and go to cash only. Then I will go bankrupt and join the hundreds out standing in line today in 96 degree weather so they can get their 25$ utility bill assistance give away money. We physicians can and MUST NOT let the government take our profession away from us. If there were ever a time for all of us to stand together and say "NO" it is now. I, for one, will not be a scab.

The devil is in the details. As I perused this yesterday, and it was brief, I found myself saying I can do that or I do that. There were a few that may have to be added (such as the codified ability to document smoking) but it didn't seem that far off. I will need to take a better look.

I have never expected to get the money. Thus, if I do, it is a windfall. I could use a windfall, but I won't hold my breath. If we are fairly close, I would like to go for it. If it will take too much..., oh well.

Again, I am in full agreement with Bert. If I were mentoring a physician considering an EHR, I would council them to NOT factor in reimbursement to their decision, but to view the EHR as a way of doing things better.. AC does that wonderfully.

I have also been dismayed that the entire system has deliberately crippled the one thing that would REALLY help; the smooth integration of records among providers. As it stands now, EHR's are like the early days of word processing, where Wordstar, WordPerfect, Apple writer and others created documents that could not be read my any other program. Why didn't the government insist on a common format, so that a patient could authorize a records release and all the records from one physician were then imported seamlessly into another's EHR? The COC record is less useful than the 3X5 card I used to carry as an intern.

David,

Agreed. I get a kick out of the one that says the EMR should communicate with other EMRs, if I am reading that correctly. Isn't that a little like saying, "Two people should be able to throw a baseball back and forth 25 times without dropping it." Isn't that dependent on the person who is least capable of catching and throwing a baseball?

AC may be capable of transmitting records very well, but if there isn't another EMR that is capable of receiving them what good does it do.

There are many programs out there such as Certified Mail or Drop Box that allow one to send an email or records to a central and secure server and the receiving entity gets an email letting them know it is there. The data never leaves the central server.

If the government wants this, then they should do like YouSendIt, Drop Box, Certified Mail and Adobe and have huge secure servers that allow physicians the capability to upload data and consultants to access it based on patient approval.

Years ago, Logician Internet bought by Medscape Encounter followed by its going out of business did have the capacity to interface with each other.

Why doesn't the legislation, CMS, HHS and the president get on national television and state that the government dropped the ball 15 years ago when they should have seen this coming and looked into designing an EMR that would do all these things. Instead, they offered a free EMR, which basically was the one used by VA hospitals. Oh, and btw, it was about as user friendly as Backup Exec.

If the first congress ran the government like they do now, we would still be paying Great Britain taxes on Lipton tea and Snapple.

Bert - you are being a little rough on Backup Exec.

From my perspective, this look like a cruel game of keep-away, where the Govt agencies keep throwing the "Meaningful Use Payout" above the heads of practitioners and taunting them with "you want this?" The best way of depriving them of their game is to ignore them and move on.

Indy,

You forget you are way more intelligent in the IT world than I. I was playing with Backup Exec on my sandbox (going against my advice of never using Symantec -- though they have done better with Veritas, uhh Backup Exec). I tried about five different ways, and I couldn't get one backup to work. Eight straight failures.

Way too hard for me. Remember, being a great program and being user friendly are two different things.