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The True Meaning of Meaningful Use

By Dr. Robyn Liu

April 18, 2011, was the opening day for a new physician incentive program that promised sizable bonuses to providers who could demonstrate “Meaningful Use” of electronic health records. DFA blogger Dr. Sultan Rahaman has written previously about his experiences trying to meet the standard set by Centers for Medicare and Medicaid Services (CMS) late in 2010.  And you can be certain that Electronic Health Records (EHR) vendors who want to sell their product to savvy practices are tailoring their software to these specifications. The bonus payment is as much as $44,000 in the Medicare incentive program, or $63,750 in the Medicaid incentive program (eligible providers must choose just one).

These incentives are nice and might provide some prodding to providers who know that they must enter the electronic age “someday” but otherwise may want to continue to drag their feet. However, the incentives aren’t enough to cover the costs, financial and otherwise, of a first-time EHR implementation. The March 2011 issue of Health Affairs included a study by Fleming, et al. of 26 North Texas practices that implemented EHR’s. They estimate a price tag of $162,000 for implementation in a 5-physician practice, with $85,500 in maintenance costs in the first year. Not only that, but each physician needed about 134 hours to prepare for the use of an EHR in clinical encounters.

Why, then, is meaningful use meaningful? What do the 15 core and 10 “menu” items on the CMS list really signify for providers and their patients?

A small private practice in rural Kansas was among the first in the nation to attest to meaningful use this April. And according to the doctor who led the efforts, it’s not about the money at all. Meaningful use, to her, is all about improving the quality of care for patients

For patients, the benefits of meaningful use boil down to better, safer care. An EHR that meets criteria will automatically check for dangerous drug-drug interactions, thereby avoiding adverse medication events. Patients can track their own lab and test results, which help them take a more active role in health maintenance. And speaking of health maintenance, a patient won’t miss her recommended screening test simply because the doctor forgot to mention it at her annual visit – the doctor will be prompted automatically based on the patient’s own demographics and diagnoses. Say goodbye to scrawled prescriptions that might get a patient Adipex instead of Aggrenox at the pharmacy: meaningful EHR programs will electronically transport accurate prescriptions. Finally, the meaningful use criteria make consistent chronic care disease management possible through required registry and quality-improvement functions.

Providers benefit from meaningful use as well. Once the system is well-learned, documentation of patient care becomes much easier, and notes can consistently be finished at the point of care (no more charting backlogs!). Enhanced documentation leads to enhanced reimbursement, as the provider can more easily get paid for the work actually done. Patient information is readily accessible, whether the doctor is at the office or on vacation overseas. Providers can ensure their treatments are evidence-based, with point-of-care clinical decision support tools at the click of a mouse.

I have heard a lot from skeptical providers who simply don’t see the value of an investment in a “meaningful” electronic system as defined by CMS. Almost any article you can read about EHR adoption will cite lack of physician buy-in as a major reason that practices never get off the ground. However, I have yet to hear from a physician who has met meaningful use and afterward declared it wasn’t worthwhile – these measures, although difficult and expensive, will make our practices safer, smarter, and ultimately more satisfying. 

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