EHR Meaningful User - To Be, or Not To Be

By Dr. Jeff Brown -Meaningful Use Mentor

Technological advancement enhances the success of any industry, and healthcare is no exception. It is easy to recognize technology’s role in the medical world—magnetic resonance imaging and arthroscopic surgery (necessary or not) are two great examples. It’s also easy to understand the reason for such improvement...would you like to have a 1950s knee surgery based on a 1950s x-ray in 2012?

Now let’s look at clinical documentation advancements. What significant documentation change has occurred in the past 60 years which improved patient outcomes? There isn’t one!

Think about it. Aside from being required to writing down more stuff, nothing has changed since 1950. Even if you transitioned to an EHR or EMR years ago, all you have done is increase your capacity to document more stuff by pushing a button instead of pushing a pen. In reality, there is nothing a ‘traditional’ EHR can do that a doctor using pen and paper can’t do. Ultimately, both doctors end up with a clinical note saved in either a paper chart or on an office computer.

It is true that traditional EHRs do benefit the individual provider because of increased documentation efficiency; however, healthcare as a whole, gains nothing. This is because the clinical knowledge amassed through your documentation, whether on paper or computer, sits idle in the office. No other provider, not even the patient, can benefit from your documentation unless you physically mail or fax this information. Even the provider, who authored the notes, is limited to really benefiting from their own documentation. They are entirely dependent on how much time and effort is spent reviewing past notes.

Enter the federal government. One role of government is to fulfill specific needs of its collective citizens which an individual citizen is not expected to fulfill on his or her own. The perfect example of this concept at work are traffic signals. You will never go down to your local hardware store, purchase a traffic signal, rent a bucket truck, and install the light at the intersection Main St. and Wall St. Instead, you entrust government, local in this case, to handle this activity for you and your neighbors.

Just like needing traffic signals to keep transportation efficient and safe, its a good idea to have universal clinical documentation standards in place to keep healthcare efficient and safe. The problem is that individual doctors do not demand highly functional EHRs which are capable of doing more than fast note taking. Therefore, the government stepped in and created the EHR Incentive Program, the intent of which was to drive technological advancement in the area of clinical documentation by putting stimulus dollars in the hands of doctors willing to do something extra. That something extra is taking clinical information, which traditionally sits idle in provider offices, and making it live through certified EHRs.

The rationale is this: If health information becomes active— meaning it’s not sitting in paper charts and useful only to a few people, and the information becomes easily exchanged between doctors, doctors and government, and even between doctors and patients—vast amounts of knowledge and efficiency will be gained. The end result for healthcare will be increased quality, and decreased cost.

The sharing of information between doctor and government is extremely limited under the EHR Incentive Program.

For the above benefits to be realized, two things must occur simultaneously. Software vendors need to develop new capabilities within their products to become “certified” under government standards and providers need to actually use these new EHR capabilities in practice. The later is termed Meaningful Use, which literally means using a certified EHR in a meaningful way.

Meaningful Use is defined by CMS and is made up of 25 requirements known as measures. Essentially, if you complete each measure, then it is proven that you have used your certified EHR in a meaningful way. You thus meet Meaningful Use and get a stimulus check.

The question is, do you want To Be, or Not to Be, a meaningful user of a certified EHR? There are positives and negatives to either answer. Let’s take a look.

To Be

Currently, the greatest positive to participating in Meaningful Use is the $44,000 (per provider) in stimulus money you can receive. This amount of money far exceeds any additional costs associated with certified software.

At this point, the only negative is the extra work required to achieve Meaningful Use. Notice I didn’t say ridiculous, overwhelming, or unrealistic amounts of work, I only said ‘extra.’ I bet the 100K plus providers who received $18,000 in 2011 will tell you the ‘extra’ work was worth it. Especially since they are eligible for another $12,000 this year!

Not To Be

The positive side of doing nothing is simply doing nothing more. Easy enough. I’ve also heard doctors say they don’t want to be on the government’s radar. The fact is, you’re already on their radar if you bill Medicare.{

The negative side to not participating is a bit more complicated. Not only would you be missing out on stimulus money and face reduced Medicare reimbursement beginning in 2015, but you’d also be left to exist in the traditional documentation vacuum of yesteryear. As the rest of healthcare becomes more and more interconnected, you’ll be left behind, wondering why no one wants to send patients your way.

To Be, or Not to Be a meaningful user of electronic health records is the question. Either conclusion may be wise for your practice depending on your personal practice goals and aspirations. When deciding, just know that the healthcare industry is taking great strides to finally bring true advancement and technology to EHRs for the betterment of everyone. And this trend isn’t going away—the benefits of Meaningful Use are long overdue and too great to be ignored.