Stakeholders at a May 20 listening session held by a Health IT Policy Committee workgroup expressed their dismay with the federal government's electronic health records meaningful use program. Some argued that Stage 2 should be the final MU stage, while others called for a further implementation delay of Stage 3.
Michael Lee, M.D., director of clinical informatics at Atrius Health, a large multi-specialty ambulatory group practice in the Boston area, told the workgroup that most eligible providers nationally will not meet Stage 2 in 2014 which should give ONC "significant pause" about moving on to Stage 3. Lee recommended making Stage 2 the final stage of meaningful use and then every 3 to 5 years add a small number of features.
"It is our view that it will take about five years before we can fully assess the impact of all of this work," he said. "Like you, we consistently want to demonstrate the importance of our work on patient outcomes. Simply raising the bar on technology may in fact reduce the success of meaningful use by focusing all the resources on meeting the needs of the program in the hopes it will improve outcomes but without any real data."
Lee asserted that the "current stage jumps" are just too large for physicians to absorb, adding that "we really need to take some pause here and really measure what we're trying to accomplish before we enforce more technology changes." Similarly, Doug Ashinsky, M.D., a solo board-certified internist at Warren Internal Medicine in Warren, N.J., advised the workgroup that they "need to take into account the data and financial burdens meaningful use has put on physicians" and "stop the meaningful use calendar," while keeping the "positives from MU Stage1 and Stage 2."
Ashinsky referenced the fact that earlier this month the Centers for Medicare and Medicaid Services released data showing that only four eligible hospitals and 50 eligible professionals had attested to Stage 2, which he called "mind-blowing."
Harris Stutman, M.D., chief medical informatics officer at MemorialCare, a six-hospital system in Los Angeles and Orange counties, Calif., told the workgroup that Stage 1 has been a "minor challenge" but Stage 2 is "really quite challenging." Stutman said that the way that Stage 2 measures are generally defined are "causing us additional angst in many areas." In particular, he noted the complexities of the transitions of care measures such as secure messaging and patient reminders on the provider side and bar code medication and administration requirements for hospitals.
Meaningless use is what physicians are calling MU, according to Ashinsky, who said that meaningful use guidelines have "forced a computer, laptop, or tablet between the physician and his patient," reducing eye contact and interaction between patient and doctor because they are "clicking, dictating or typing on the computer to meet actuarial and bureaucratic endpoints."
Stakeholders at a May 19 eHealth Summit hosted by the Centers for Medicare and Medicaid Services also criticized time-consuming data entry and interference with face-to-face patient care as two negative byproducts of physician use of EHRs.
"Doctors aren't robots and can't enter 5 million things [into an electronic health record] during a visit and still focus on the patient," said Margot Savoy, M.D., medical director of family medicine centers for Christiana Care Health System. "Patients tell us that we spend a lot of time with our faces in computers and not a lot of time listening to them and hearing what they have to say."
Savoy further argued that "if you all of a sudden have to hire a scribe or a nurse to make sure the data gets in the right spot, all of those savings just get lost in another salary and another person having to be there to make it happen.
The May 20 Health IT Policy Committee listening session, which heard from eligible professionals and hospitals, was the first of two planned by the Meaningful Use Workgroup. Another session on May 27 will focus on accountable care organizations, EHR developers/vendors, payers, purchasers, and Regional Extension Centers.
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