Jarrod Shapiro, DPM
MeaningLESS Use?

Just this past week, the medical director for my practice at Western University sat a few of us down and explained how we would be instituting Meaningful Use with our Electronic Health Record system. As he was explaining all of the extra steps we would be taking with our charting, one thought occurred to me: "Electronic medicine is here, and I don't love it."

What is Meaningful Use?

For those of you either new to medicine or are desperately trying to ignore all the coming regulations, let's do a quick review.

Meaningful Use is a method for physicians to prove their electronic health record technology is functioning to improve the quality of patient care, improve coordination, improve public health, and ensure privacy and security in patient health information. The overall gist is that physicians are using their electronic health records in meaningful ways to improve health care.

Lofty goals, huh?

This program started in 2009 with the American Recovery and Reinvestment Act and is set to implement in three phases. In the first phase, physicians were given a monetary incentive by Medicare to demonstrate Meaningful Use.

Now, as phase 2 is about to start for some (depending on the type of system used), if meaningful use is not achieved, physicians will receive a decrease to their reimbursement of 1% in 2015, 2% in 2016, and 3% in 2017 and each year thereafter. For some of us this could be a significant decrease in payment. And who knows if the private health insurance companies will follow suit?

In order to be considered as passing stage 1, providers must demonstrate use of 13 core measures and five of nine menu measures. When stage 2 comes, it gets worse. Here's a list of the stage 1 requirements.

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Core Measures (ALL providers must do these)

	1.	Use CPOE (Computerized Order Entry) for medication orders.
	2.	Implement drug-drug and drug-allergy interaction checks.
	3.	Maintain an up-to-date problem list.
	4.	Generate and transmit non-controlled prescriptions electronically.
	5.	Maintain an active medication list.
	6.	Maintain an active allergy list.
	7.	Record patient demographics.
	8.	Record and chart changes in vital signs.
	9.	Record the smoking status for patients 13 years and older.
	10.	Implement one clinical decision support rule.
	11.	Provide patients with an electronic copy of their health information.
	12.	Protect electronic health information created or maintained by the certified HER technology through the implementation of appropriate technical capabilities.
	13.	Provide clinical summaries for patients for each office visit.

Menu Measures (Providers can select from the list)

	1.	Implement drug formulary checks.
	2.	Incorporate clinical lab test results into HER as structured data.
	3.	Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
	4.	Send reminders to patients per patient preference for preventive/follow-up care.
	5.	Use certified HER technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
	6.	The provider who receives a patient from another setting of care or provider of care of believes an encounter is relevant should perform medication reconciliation. (ie, whenever care is transferred you should reconcile the medications).
	7.	A summary of care record should be reported for each transition of care.
	8.	Capability to submit electronic data to immunization registries.
	9.	Capability to submit electronic syndromic surveillance data to public health agencies.

For more detail on the specifics, click here.

Now, I'll grant you this looks like pretty boring stuff, and I agree. But it turns out to be very important. Luckily, a good number of these measures should be built into your electric health system (for which you pay a pretty penny, I'm sure). Also, your staff can handle a good number of these. But keep in mind that you're adding yet more work to your likely overworked assistants.

For me as an employee of a larger institution with an entire team to handle all of the administrative aspects of these additions, it's only a moderate inconvenience, elongating my already tedious charting. But for those in the profession who remain sole proprietors, this adds a lot of work to a small practice and a large cost with questionable benefits.

The bottom line question is this: will the Meaningful Use requirements actually improve patient care?

I doubt it.

We are now forced to supply so much data that we're swimming in it. Sounds like meaningLESS use to me.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]