I’m feeling meaningfully used today.
Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested.
An “eligible professional summary” arrives in my email, with lots of bars with lines, and green checks or red Xs. “Incorporate clinical lab test results” must be greater than 55%, “record patient demographics” must be greater than 80%. Scanning the right-hand column, I get a little burst of adrenaline and pleasure for each green mark, and a pit in my stomach for the red ones.
Somewhere, somehow, someone decided that reaching these levels of these particular markers were proof that we are utilizing our electronic health record to its fullest potential. Meaningfully using it. And, in turn, that this meant we were using the electronic health record (EHR) to take good care of our patients. And by extension, taking good care of our patients.
A lot of assuming.
Simply using an electronic health record, we are nearly guaranteed many of the meaningful use basic measures. All of our orders are now electronically entered, so this one cannot be less than 100% on an audit. Medications must be reconciled. Vital signs and smoking status are built in hard stops in the EHR, so another win.
But suddenly there’s a new one: P215 — send reminders to patients. And once again I’m that bad doctor. 0% — I have a big red X next to my name. Zero of 1004 patients that the auditing program randomly sampled from my charts.
But wait! How could I send reminders to my patients when that functionality in our electronic health record has not yet been turned on?
A patient of mine who works in health care and knows about this mandate recently sent me the following message through the patient portal, clearly only to help me qualify:
“Hello Dr. Pelzman, I am sending you a MyChart message to meaningfully connect with you. It is a pleasure being your patient! Best, B.”
Well on my way greater than 10%.
Once the “reminders to patients” widget in the EHR gets turned on, we will undoubtedly find a way to quickly and easily reach that required 10% goal.
This, however, is not the point.
We need to get over this anxious desire to please the auditors, and learn to make using an EHR, for us and for our patients, a kinder and gentler experience. A healthy experience. The EHR should work for us, not us for it.
For now we will all continue dutifully clicking the buttons, but all along I want us to keep thinking about how we can use this technology to make health care better. Which patients will benefit from messaging, from getting their labs via email, from getting refills with a click of a button? Many will. Some will not. Some will always need to call, or walk in, or just expect it to happen as if by magic.
Patients are all different, and providers are all different, and how we interact with this new technology needs to be an organic, evolving process, which should not be forced. There is great potential gain in using an EHR, but the answer does not lie in crossing thresholds — rather, it lies in seeing where it will take us.
Hopefully somewhere meaningful.
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.