But is the meaningful use program creating better doctors? Are they moving past adoption of federally required EHR functions with a new appreciation of the technology's capabilities?
For five physicians who have become meaningful users, the answer are "yes" and "yes," which comes as a bit of a surprise to themselves, since some first viewed the EHR incentive program as a bureaucratic and rather meaningless-pun intended-process.
But as it turns out, the data they "meaninglessly" collected to jump through the government's hoops and get incentive payments is proving useful in identifying patients needing more attention, adopting best practices and tracking progress of new treatments.
PERCEPTION VS. REALITY
Peter Basch, M.D., an internist and medical director for ambulatory EHR and health I.T. at Baltimore-based MedStar Health, has been using electronic records since 1997 and is a meaningful user. As of mid-summer 2012, about 70 percent of MedStar's ambulatory physicians have attested or were ready to attest.
Meaningful use is valuable even for the most veteran EHR users, contends Basch, who uses a records system from GE Healthcare. "Those of us who thought we were doing everything well went through the rigors of meaningful use and many of us found that our perception was different than reality. And in those instances, it was typically a matter of consistency. While we often used the EHR optimally, it was not consistently optimal."
There are many new EHR users at MedStar who, because of the relentless focus on meaningful use reporting, became comfortable with the basics in a relatively short period of time, Basch adds. "Optimizing use of the EHR as a component of ordinary practice presumes doctors are competent with the basics."
That comfort level is doubly important because MedStar is a participant in the Department of Health and Human Services' new Million Hearts program to prevent 1 million heart attacks and strokes over five years. The core of the Million Hearts program is to follow the "ABCs," a series of primary care screenings of patients-regardless of the reason for a patient visit-that stands for: an aspirin regimen when appropriate for primary prevention of cardiovascular disease; blood pressure screening and control; cholesterol screening and control, and smoking status identification along with aggressive cessation efforts for current smokers.
Basch now is re-tooling the EHR to make following the ABCs easier for physicians and patients. The Million Hearts program has a big emphasis on best practices, "and that's what the EHR enables us to do."
As the medical director of I.T., Basch occasionally meets with the chief medical officers throughout MedStar, who often are annoyed by Basch and the message he has to deliver about more regulations being piled on the practice of medicine.
But at the last meeting, Basch made a presentation on the Stage 2 meaningful use requirements as proposed, followed by a presentation on the Million Hearts program. One of the CMOs in attendance was a regular thorn in his side, always protesting how much one regulation or another-especially meaningful use-was going to be burden to physicians. This time, after hearing about MedStar's new commitment to using the EHR for the Million Hearts program, he stood up and said, "Now this is meaningful," Basch recalls. "He finally understood the value of meaningful use and how it paved the way for this Million Hearts program, and really paved our way to be successful with it."
CHANGE OF HEART
Jonathan Schreiber, M.D., and his wife Beverly Kelsey, M.D., are co-owners of a small gastroenterology practice in Baltimore and Towson, Md. Schreiber was an early attester of the Medicare meaningful use program in the spring of 2011 using an EHR from Amazing Charts. Going through meaningful use was frustrating and sometimes felt pointless, he recalls. "I believed portions of meaningful use were nothing more than a lot of clicking."
For instance, he initially thought it was a waste of time to document language and ethnicity, in part because many patients are suspicious about why ethnicity has to be recorded. But the practice recently adopted a new, highly effective treatment regimen for Hepatitis C-a regimen that is most effective when tweaked for Caucasians and African-Americans, which convinced Schreiber of the value of collecting ethnic data.
The new treatment-which Schreiber says provides a cure for Hepatitis C for nearly 70 percent of patients-is intensive and includes three powerful and very expensive drugs that are sometimes physically draining and have side effects, requiring frequent visits between doctor and patient.
The drugs cost $60,000 to $80,000 a year per patient and insurers require a mountain of documentation to confirm the medication is appropriate for the patient. Without the EHR it required two or three hours for the physicians to get the information together for approval; now it takes 10 to 15 minutes. "We literally could not be treating the number of people we're treating without the EHR," Schreiber says.
Schreiber doesn't yet consider himself to be a meaningful user of the EHR reporting functions, although he's getting better. An interface with Lab Corp. lets codified data be directly entered into the EHR, enabling him to track the degree of anemia in patients being treated with the Hepatitis C drugs, as well as various other parameters. Another report can identify patients previous treated for Hepatitis C who may benefit from the new treatment. And he wants to more broadly use other reporting functions, such identifying patients due for a colonoscopy and tracking whether they had the procedure.
So, going through meaningful use may have at times seemed pointless, "but it opened my eyes exactly to what an EHR does and can do," he adds.