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Meaningful Use or Useless Meaning?

December 19, 2012

There’s a lot of money in health care information technology these days.  Two funding sources, the American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health Act, have combined to provide 60 billion dollars in funding for doctors and hospitals to invest in electronic medical records.  To get the money, though, providers have to prove that they are making “meaningful use of certified EMR technology”.  I have to credit Nicholas Terry in an article out of St Louis University School of Law for most of this information.

Here’s some lawyer/medico/politico speak for you: meaningful use is “a series of concepts arranged in a relatively hierarchical matrix consisting of goals, objectives, and measures (or compliance metrics) expressed across a timeline.”  Awesome.  Translation?  Basically it means that your doctor has to prove that he’s using his EMR to treat patients; that the system isn’t in a corner gathering dust or used by the staff to check their email, while he pockets part of the 60 billion.  As of July 2012 there are 15 core objectives that providers have to satisfy to qualify for EMR funding plus a menu of 10 more of which 5 have to be satisfied.  These objectives are generally easy-to-measure, somewhat random stuff you have to document, for instance using EMR to document smoking status of patients, as well as using technology to do things like write prescriptions.  These criteria are stage 1. There are 2 more stages with more advanced objectives.

Since the Affordable Care Act was passed, attempts have been made to link EMRs to quality and cost concerns, with mixed results.  An Archives of Internal Medicine article in 2011 looked at 19 outcome measures and found that EMRs made no difference in those quality indicators.  The journal Health Affairs published an article written by the government proponents of EMR that made EMRs look much more effective at improving quality.  Meaningful Use criteria are basically just quality indicators, chosen because they are easy to measure.  They don’t actually guarantee quality.   There isn’t any evidence that documenting the smoking status of all your patients makes you a better doctor.

Resistance to all this by physicians has been predictable.  Doctors are human.  Humans tend to be more likely to do something if there’s something in it for them.  Right now there’s a lot of paperwork, a lot of regulation, for maybe a little money but no improvement in the way things are actually done.  It doesn’t make anything EASIER.  The overarching lofty goal of EMR is to make all the data available to everybody, all systems cross-talking, all programs linked.  This won’t be accomplished by Meaningful Use criteria or any other regulation.  It’s all about the money, baby.  People will pay for something that works, that makes things EASIER.  The innovator who can come up with a way to do this won’t need government funding, and physicians won’t need incentives to adopt it.

 

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