What is “Meaningful Use”, What EMRs should be “Certified” and Who should do the Certifying

Posted on July 27, 2009 I Written By

Because of all the money being thrown at doctors and hospitals as part of the HITECH (Health Information Technology for Economic & Clinical Health) Act, a component of the ARRA (American Recovery and Reinvestment Act), it becomes important to use certified EMRs in a meaningful way.

It has always been important to use EMRs in a meaningful way, but now you can get paid ($44,000 per physician) if you jump through hoops created by organizations like CCHIT which is the Certification Commission for Healthcare Information Technology, who want to make money for their executives and suppress competition for their top clients. The government has put the wolves in charge of guarding the hen house. Diversity, choice and competition have taken a back seat to self-serving regulation based on big business payoff of our government at its highest level (the big EMR companies have bought Obama). This is truly breathtaking and incredible (see BusinessWeek May 4, 2009, page 31-37)! The best way to stunt the development of any system is to suppress diversity, choice and competition by putting the rich and powerful in charge. The people in charge want to make more money, they don’t want better EMRs and they don’t want what is best for our healthcare system.

Today’s blog is going to be a little different. I am not going to comment on the present criteria used for CCHIT certification and I am not going to comment on the current state of the “meaningful use” definition. I KNOW what “meaningful use” is. I am a doctor, I have an EMR … I know “meaningful use” when I see it. Walks like a duck, quacks like a duck, looks like a duck. All doctors KNOW intuitively what “meaningful use” is.

I am not going to comment on the specifics of CCHIT Certification Criteria because I KNOW it is not optimal. Tear it all down and let’s start from scratch. It may have served a purpose in the past to move the industry forward, but it has now become a problem. It inhibits innovation, diversity and choice. It costs too much, it is too complex and many very good EMRs are not CCHIT certified. Company’s are wasting their time, money and effort to get certified rather than improving their EMR product! CCHIT’s primary purpose now seems to be self-preservation at any cost. Their executives want to preserve their six figure incomes at any cost.

Instead of commenting on what others have said about these two issues, I am just going to tell you what I think … I am going to keep it simple.

Any EMR that can be used in a meaningful manner should be certified. Period. End of the certification problem. My definition of meaningful use is so simple and so intuitive that certifying an EMR becomes very easy. So easy that you don’t need to pay much money and you don’t need an organization like CCHIT. You can hire a CPA or an Accountant to do the certifying.

Any EMR should be certified if it can do everything listed below. If it can do these tasks, it is being used in a meaningful manner and thus satisfies the “meaningful use” requirement.

What an EMR must do:
●Document a Progress Note
●Store, Index and Provide access to Lab Results, Test Results, Hospital Reports and Consultation Reports
●Store and Track Wellness information for Chronic Conditions like Diabetes (Fasting Blood Sugars, HgAICs, Eye Exams, Kidney Tests and Foot Exams) and Coronary Artery Disease (Blood Pressure, Cholesterol, EKGs, Stress Tests, Echocardiograms, Catheterizations, Cardiac Consultations).
●Store and Track Health Maintenance Information for Routine Care of Adults and Children (Flu Shots, Pneumonia Shots, Immunizations, Mammograms, Pap Tests, PSA, Colonoscopies, Bone Density Tests)
●Write Prescriptions
●Write Orders
●Help Select Diagnosis Codes (ICD-9 and CPT Codes)
●Help Select Level of Care Codes (Evaluation & Management (E&M) Codes)
●Perform Scheduling, Billing and Intra office Messaging OR Interface with a Practice Management System
●Collect and Report data for Quality Improvement Activities and Pay-for-Performance Activities
●Connect with Regional Health Information Exchange Platforms (HIE Platforms) AND be able to Import and Export Data in the Continuity of Care (CCR) or CCD Format

If an EMR can do the above tasks then it is being used in a meaningful manner and it should be certified. My background is Internal Medicine, so there may be adjustments that are need for certain specialties. Some may feel that I should include a patient portal and clinical decision support in the above criteria.

Let’s not overcomplicate this EMR thing. We want doctors using an EMR and we want companies coming up with better EMRs which help doctors provide better, more efficient care at a lower cost. The only way to achieve these goals is to let the market place select the best EMRs. In order to do this, you need innovation, variety and choice. You have to nurture and support small companies. We have to encourage people to get into the EMR business rather than create barriers to entry. Using CCHIT certification and possibly a complicated definition of “meaningful use” we risk inhibiting innovation by snuffing out new and small companies with regulations that are not practical, helpful or wise.