A national survey of family physicians finds that, for many doctors, the Meaningful Use program has created a significant practice burden without clear benefits to patient care.
The survey of 480 family doctors, conducted by an interdisciplinary national panel of experts formed by American Academy of Family Physicians, sought to identify the work associated with 31 MU criteria during patient encounters and to assess each criterion’s level of patient benefit and compliance burden.
“Eighteen of 31 MU criteria were perceived as useful for more than half of patient encounters, with 13 of those being useful for more than two-thirds,” according to the authors of the study, which was published recently in the Journal of the American Medical Informatics Association. “Thirteen criteria were useful for less than half of patient encounters. Four useful criteria were reported as having a high compliance burden.”
Based on the survey, high-benefit MU criteria include: maintaining an active medication list; generating and transmitting electronic prescriptions; maintaining an active allergy list, incorporating clinical lab test results into an EHR, as well as performing drug allergy checks.
At the same time, those surveyed pointed to these high-burden MU criteria: performing drug formulary checks; providing a summary care record for each transition of care or referral to the next transition of care; using secure electronic messaging to communicate with patients; providing a clinical summary for patients after each office visit; implementing one trackable clinical decision support rule, and providing patients with electronic copies of health information within four days of its availability.
Further, four MU criteria were designated as both high-benefit and high-burden: recording electronic notes in patient records; maintaining a current problem list with active diagnosis; performing medication reconciliation when receiving a patient from another setting or care provider; as well as using computerized physician order entry for new or renewal medication orders.
Grady Talley Holman, lead author of the study and an adjunct professor of industrial engineering at the University of Louisville, describes MU criteria as merely a list of tasks that physicians perform. “It’s a checklist of whether doctors did it or not in the computer—it is not a checklist of did they use it effectively in practice,” says Holman.
The authors contend that their findings “call into question the level of functionality and support EHRs provide to physicians, given the volume of significantly burdensome criteria reported” in the survey.
In addition, researchers found that most physicians surveyed perceived a negative shift in the value of MU as it moved from Stage 1 to Stage 2.
While the survey reveals high variability in physicians’ perceptions of the benefits and burdens of MU requirements, it showed that “Stage 1 criteria, which are more related to basic/routine care, were perceived as beneficial by most physicians” and “Stage 2 criteria, which are more related to complex and population care, were perceived as less beneficial and more burdensome to comply with.”
“Policymakers need to have this kind of retrospective data in hand before they implement policies rather than after if they are to avoid the missteps of Meaningful Use,” said Steven Waldren, MD, one of the study authors and director of the AAFP’s Alliance for eHealth Innovation. “Doing so will increase the likelihood that policy goals are achieved.”
Toward that end, researchers recommended that policymakers:
- Support MU criteria with high benefit and low burden
- Recognize that mandating tasks that are not beneficial to the majority of patients diverts attention and effort away from direct patient care
- Minimize burdens associated with beneficial routine tasks through better EHR design to allow for the addition of more complex patient-specific tasks
- Refrain from setting compliance metrics at 100 percent to allow for adaptive patient care, and
- Minimize burdens associated with low-benefit tasks by automating them through EHR reporting.
“This study suggests that policymakers should not assess MU in aggregate, but as individual criteria for open discussion,” conclude the authors.
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