Wednesday, September 30, 2015

Is Meaningful Use Meaningful?

The EHR/EHR is moving forward in its Government mandated manner but signs of revolt may still be simmering. In MedPageToday they report:

...Amherst, Mass, said that three of the physicians who left her practice in the last year did so because of frustration with the Meaningful Use requirements. She said the practice underwent an expensive audit associated with the program that lasted more than a year, which had the ironic effect of delaying other programs aimed at improving patients' health. If Stage 3 goes into effect, ... said, she will be obliged to stop accepting Medicare patients, leaving 1,500 elderly and disabled patients without a primary care doctor. "I couldn't take care of my patients and take care of myself," she said. Another physician mocked the requirement for a certain percentage of patients to use online patient portals to communicate with doctors. He said he has his secretary log in his patients, most of whom are geriatric, so that they can send "a note of clinical relevance... which says 'hi'."

There are levels of problems here. First is the ability of the physician to enter "meaningful" data. For the most part it is cut and paste. Second is the ability to look at trends. Medicine often is seeing if anything has changed; HbA1c, PSA, BP, weight, etc. Change and rates of change are critical. I see this in monitoring HbA1c and PSA levels, yes PSA levels. Sample blood glucose are useless, HbA1c is a 90 day average. It has value. Single PSA is meaningless, velocity is prognostic. Most EHR make one fumble for those metrics. Third, try and get them to interconnect! Even in an integrated hospital system. Take New York Presbyterian. Cornell does not communicate with Columbia, and patient portals are separate and patient appointments are catch as catch can.

They continue

...a pediatrician from Leominster, Mass., agreed that certain metrics were inappropriate for certain specialties. "I think of this every time I check the blood pressure on a screaming 3-year-old who has an ear infection." And a number of physicians, ..., commented on the futility of punishing providers for the failures of technology vendors. Stack said he has the knowledge and expertise to take a patient whose liver has ruptured through numerous protocols and into the operating room in just enough time to keep the patient from bleeding to death internally. " I shoudn't have to write the software code for the electronic health record at the same time."

 It continues:

a professor at Harvard University and a researcher for the Children's Hospital Informatics Program at Boston Children's Hospital, said EHRs should be as adaptable as the apps on an iPhone. "If the makers of Angry Birds want to add a new bird they don't have to fly to Cupertino... to figure out how to do that."

 I could not have said it better myself!