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Wednesday, November 26, 2014

Pardon the MU turkey?

RIP Meaningful Use Born 2009 – Died 2014???

The policy known as Meaningful Use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers.

Because I believe that Meaningful Use is now doing more harm than good, I see these events as positive developments. To understand why, we need to review the history of federal health IT policy, including the historical accident that gave birth to Meaningful Use...

...I believe the policy decisions were sensible. And for a while, everything went pretty well. Meaningful Use Stage 1, implemented in 2010-12, consisted of achievable standards designed to ensure that EHRs were being used effectively. But it was not so prescriptive as to stand in the way of the primary goal, namely, wiring healthcare. Adoption rates soared and MU ensured that the computers were being used.

With Meaningful Use Stage 2 (2012-present), things went sour. The standards became far more aggressive, veering far more deeply into the weeds of clinical practice. MU now dictated how doctors should give out handouts to their patients (they must be prompted by the computer). It held doctors and hospitals responsible for ensuring that patients viewed and transmitted their data to third parties (most patients had no idea how to do this). It forced EHRs to meet onerous disability access requirements. All of these are noble goals, but all are bells and whistles – the kinds of changes you make after you’ve nailed the basics of getting the darned machines to work safely and efficiently...
Interesting post. Read the entire piece.
In the past six months, in fact, more than half of ONC’s senior personnel – its chief scientist, chief nursing officer, chief privacy officer, and director of consumer eHealth – have jumped ship.

I worked in the Meaningful use program for one of the RECs from its inception until I retired last year. I never liked the phrase "meaningful use" -- effective health IT use is what we need for improved patient outcomes, and the MU criteria comprise weak neonatal steps proxies for that. And, CHPL "certification" is an expensive joke. But, conversely, I find the overwrought whining about the putatively lethally onerous standardized data capture criteria equally fatuous. A typical 99123 outpatient encounter workflow, for example, will require the accessing, viewing, updating/editing/appending, perhaps transmitting, and evaluating (SOAP) of hundreds of variables (or more) in a patient's record. The numerator/denominator "structured data capture" MU criteria comprise about two dozen (including the CQMs), and most of those can be handled at the sub-MD support staff level, with minimal workflow adjustment (and, most of those MU vars you'd likely be capturing anyway, albeit in haphazard fashion). That's not theoretical for me; it was my job to help REC clients do precisely that.

Trying to shoehorn all of that necessary logistical and analytical work into a 20-30 minute patient visit is the real problem.

More from Dr. Wachter:
Rather than continuing to push highly prescriptive standards that get in the way of innovation and consume most of the bandwidth of health IT vendors and delivery organizations, MU Stage 3 should focus on promoting interoperability, and little else. Last month, an expert panel presented ONC with a reasonable set of recommendations calling for standardized, publicly available application programming interfaces (APIs), the EHR version of standardized light sockets. This change would allow EHRs to communicate with each other and developers to write apps that could link to the large systems like those built by Epic and Cerner. Promoting this kind of interoperability would be a judicious role for a smaller, less muscle-bound ONC, and for MU Stage 3.
"the EHR version of standardized light sockets?"

I've been making that type of analogy for a long time. See my "Interoperabbable" posts.
"Visualize going to Lowe’s or Home Depot to have to choose among 1,848 ONC Stage 2 CHPL Certified sizes and shapes of 120VAC 15 amp grounded 3-prong wall outlets."

I hope everyone has a safe and happy Thanksgiving holiday weekend, btw. Glad I don't have to travel. Happy 34th anniversary to my wife and best friend (this Friday).

More to come...

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