Give meaningful use value for physicians

Before I took over one of the classes that now teach at the medical school, I asked students why the value of that class was so low.  One of the reasons they gave was that it was so hard to do well in the class, and there were so many other things to study, students only put in enough effort to pass.  In other words, incentives are only good if they are both valued and attainable.

As this related to electronic medical records (EMRs), achieving meaningful use is not easy.  The technology for clinical decision support (a requirement) is not quite ready for prime time.  Nor is there an easy way to share parts of the EMR with patients.  In a study of almost 600 docs who had been using EMRs, most were confident that they would qualify for meaningful use and get bonuses for doing so.  However, the survey also found that the majority of these physicians would not meet some of the criteria.  Thus, though the financial incentive seems nice, the path to getting these incentive may be so unattainable that physicians won’t waste the effort or expense.

More importantly, some of the “stuff” that’s meaningful in meaningful use, may not have value for physicians. Policy makers that developed these criteria were understandably thinking on a population level (lowering blood sugar in a population of diabetics).  However, physicians are used to dealing with patients one on one.

A recent survey of EMR using physicians was done over at Software Advice regarding the advantages of using EMRs.  Granted 50 respondents may not accurately generalize to most physicians; however, some of the results are telling.  What do doctors like about EMRs? Greater accessibility of charts, easier to read notes, more accurate patient information, and improved coordination of care by having the ability to share data.

As a user of EMR’s for well over a decade, I would concur with these findings. EMR’s are far from perfect, but based on these advantages, I could never go back to paper.  What  “benefits” of EMR’s did doctors not see as readily? Improving preventative care, opportunity to participate in pay for performance, improving clinical decision making, and reducing errors/improving patient safety.

Thus, under the current plan to increase EMR use by physicians, the financial incentives may be too hard to achieve and the purported benefits may not be easily perceived.  This combination does not bode well for the adoption of EMRs by most physicians.  Instead, policy makers might want to consider a different approach.

First, rather than create a financial carrot that will be too difficult to achieve for most, use that money to reduce barriers to adopting EMRs in the first place.  Second, instead of focusing on the benefits important to policy makers, focus on benefits that are important to physicians, such as making our work easier and more productive.  This is important because EMR vendors design their products on what they believe will meet their customer’s needs.  The first EMR platforms focused on improvements in billing and coding to capture more revenue.  Now, vendors are focused on helping physicians achieve meaningful use.

If vendors focused on making a physicians work easier and more productive (and policy maker made it easier to adopt these tools), EMR adoption would be much greater than it is now.

Matthew Mintz is an internal medicine physician who blogs at Dr. Mintz’ Blog.

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  • Anonymous

    I have been using EMR for 6 years and I still want to strangle the creators of Allscripts on a daily basis for adding another 2 hours minimum to my workday. I see less patients due to the documentation burden and my income is way down. However, the benefits stated in the above article are true and paper definitely is inferior in those respects. Why can’t Google or Apple work with these idiots at Allscrpts so doctors can be more productive? I would love to help my kids with their homework but I am constantly connected to my computer trying to finish notes. Oh, by the way, I also like to look my patients in the eye during their visit instead of fixating on the computer so sometimes feel I am to blame for caring about my patients. Steve Jobs was my last hope – please someone like him help us physicians!!!!

  • Anonymous

    Dear Happydaysdoc,

    We too have one of the varied EHR programs of Allscripts named Professional EHR formerly known as A4′s Healthmatics. They have numerous systems as they have either bought by or have bought several other EHR companies and have numerous active versions of each system that they own and each new version of the EHR that you purchased for your practice is being laid on the original, old platform that you purchased. Because of this their customer service reps cannot answer questions and sometimes it takes them days to find the guy still at the company that knows the answer. We have had  a problem burning pt records to CD as the PDF compresses and within a few pages the document becomes darker and darker and blackens out.

    We trained our MAs to be scribes during the visit, and also obtain all of the varied, multiple reasons the patient is seeing their PCP that day, pulling down diagnosis and refills, etc. While the Dr is “looking the patient” in the eye. The doctor still has hours of work after hours to review records, do out of office refills/messages.

    Early next year we are moving to athenahealth. Yes, they will take a percentage of all receipts, even Meaningful Use stimulus dollars, but will take all incoming paper and index it to the chart while at the same time researching the documents for Meaningful Use criteria which will save so much practice time we may be able to either replace or redirect duties of an employee, they will also replace the cost of the statement/billing/clearinghouse cost, and help practices get to stage III medical home. With money, time, anxiety saved, percentage of all receivables seems very reasonable.

    • Anonymous

      That sounds great – and well worth it especially if it saves employees and that much time. We are a very large hospital system that employs mainly primary care (I am internist) and some specialists so that is really good to hear positive things. I like the scribe idea but my MA is also responsible for doing referrals and calling patients – may change workflow but could work for sure!!

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