How Meaningful Use Mandates Lost Their Purpose

~ by Linda M. Girgis, MD

The meaningful use program began as part of the HITECH stimulus bill, part of the initiative to get all healthcare providers on EHR systems. The meaningful use (MU) program was established to provide an incentive for compliance. In the early stages, physicians who met reporting requirements were given a cash bonus. This year, however, doctors are now being penalized if they haven’t qualified. Penalties are being taken out of the reimbursements we receive when we provide medical care to patients.

Many doctors certified for the first two steps of Stage 1 MU but his stumbling blocks with Stage 2. MU2 implementation has been delayed several times due to software issues with poor reporting metrics and hospital IT departments struggling to get their infrastructure up to speed. Hospitals and private practices are pouring money into integration solutions while doctors lament the MU changes are irrelevant to clinical practice. EHRs should improve medical outcomes of patients; many doctors don’t think this objective is being met.

Why do doctors think MU is meaningless to patient care?

• The metrics doctors are required to report often bear no relevance to the patient we are treating. For example, we are supposed to record a patient’s smoking status at every visit. It seems ridiculous to most doctors to record smoking status on infants. But, that is an MU requirement.
• Pertinent information is often buried in a patients’ record, cluttered by some many metrics that aren’t relevant. This eats into patient/doctor time and can delay treatment. Often the tedious task of checking boxes doesn’t promote good clinical outcomes.
• Doctors now spend an unprecedented amount of time just charting. But it’s more about fulfilling MU requirements than recording necessary patient information. Doctors want more face time with patients, not less.
• To meet the requirements of MU stage 2, patients need to communicate with their physician through a patient portal. Many doctors had trouble getting their portals active because the software vendors had difficulty interfacing the portal to the practice’s EHR system. Some patients simply do not want to communicate through portals, should we force an unwanted system of communication on them? However, a practice gets dinged if a patient chooses not to use the portals, even among patient populations that don’t have emails such as the very poor and the elderly.

Complying for MU in a large system is difficult, costly and time-consuming. But, hospitals and large networks have whole IT departments with staff devoted to that task. Imagine what it is like for smaller practices, many who are already struggling to stay afloat financially. We do not have IT departments nor extra staff. I have a storage closet with three routers networking all my systems. When one goes down, so does my practice. In order to comply with the first stage, we had to devote one of our staff full-time for several weeks. Our employee was not an extra hand we had on deck, but someone we had to pull from her usual duties. We ran our practice short-handed, and it was stressful for all involved. The bonus we received barely compensated for our lost time with that employee.

Those of us in the white coats, practicing medicine daily, see MU2 as a barrier to improved patient care. While we can see the potential, doctors MUST be more involved in the design. Big data in medicine is a big deal, we hope aggregated information via the EHR system will provide valuable insights in the years to come. But it must be a real-world, workable system that always keeps the patient foremost in mind.