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Rep. Phil Gingrey Comes After Healthcare Interoperability and Epic in House Subcommittee

On July 17th, the House Energy and Commerce Committee’s subcommittee on Communications and Technology and Health (that’s a mouthful) held a hearing which you can see summarized here. Brought into question were the billions of dollars that have been spent on EHR without requiring that the EHR systems be interoperable.

In the meeting Rep. Phil Gingrey offered this comment, “It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer.”

At least Rep. Gingrey is a former physician, but I think he went way too far when he used the word fraud. I don’t think the fact that many EHR vendors don’t want to share their healthcare data is fraud. I imagine Rep. Gingrey would agree if he dug into the situation as well. However, it is worth discussing if the government should be spending billions of dollars on EHR software that can’t or in more cases won’t share data. Epic was called out specifically since their users have been paid such a huge portion of the EHR incentive money and Epic is notorious for not wanting to share data with other EHR even if Judy likes to claim otherwise.

The other discussion I’ve seen coming out related to this is the idea of de-certifying EHR vendors who don’t share data. I’m not sure the legality of this since the EHR certification went through the rule making process. Although, I imagine Congress could pass something to change what’s required with EHR certification. I’ve suggested that making interoperability the focus of EHR certification and the EHR incentive money is exactly what should be done. Although, I don’t have faith that the government could make the EHR Certification meaningful and so I’d rather see it gone. Just attach the money to what you want done.

I have wondered if a third party might be the right way to get vendors on board with EHR data sharing. I’d avoid the term certification, but some sort of tool that reports and promotes those EHR vendors who share data would be really valuable. It’s a tricky tight rope to walk though with a challenging business model until you build your credibility.

Tom Giannulli, CMIO at Kareo, offers an additional insight, “The problem of data isolationism is that it’s practiced by both the vendor and the enterprise. Both need to have clear incentives and disincentives to promote sharing.” It’s a great point. The EHR vendors aren’t the only problem when it comes to not sharing health data. The healthcare organizations themselves have been part of the problem as well. Although, I see that starting to change. If they don’t change, it seems the government’s ready to step in and make them change.

July 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

The Impact of Meaningful Use on EHR Development

I’ve been getting a really strong response to my post calling for EHR vendors to expand their definition of customer service. Although, the title doesn’t do the post justice since I also talk about the impact of meaningful use on EHR development. Many of the readers of EMR and HIPAA (and if you don’t read EMR and HIPAA you should go subscribe to the emails now) have highlighted some important points I wanted to share with a broader audience.

First, Peggy Salvatore provides this insight about the impact of billions of dollars of EHR incentive money:

Almost 15 years ago, I wrote material for Intel (the computer chip company) based on research they were doing on physician workflow to make EHRs more usable. It was one of the early efforts to tackle this issue. I mention this to say that a lot of spade work has been done in this field but (in my humble opinion) government regulation has gotten in the way of software businesses trying to build electronic patient record products that work for the end users. Experience has shown time and again that customers will drive product improvements, and the same is true in the healthcare industry as in all others. The government has wasted tens of billions of dollars requiring systems be installed to meet timelines that were not realistic given the budgets and time available, or, to this point, to install products that were not really ready for prime time. Let the customers – in this case – the providers and the patients – drive development and you will end up with products that solve problems, not create them.

Brenden Holt, CEO of Holt Systems, offers this startling commentary on the EHR industry:

To me it is more clear. EHR Vendors, large and small and all points in between are currently working on the support nightmare (R&D and Direct Support) of Meaningful Use. It is the same when CCHIT was coming out, and not much different then the 100′s, if not 1000′s, of current copy cat products, all in one way or another a copy of the master Logician (GE).

Innovation does not bring in customers in the current environment. Government Adherence and more importantly relationships (Marketing and Sales) accomplish this. That is to say products need to be improved upon, but only to the extent of meeting the Government Regulatory Demands and the demands of the Large Organizations that are buying these things in bulk.

Innovation is available, but more then likely will take some time, as will thinking of how we document patient care as a whole, which is antequated methodology.

So as a CEO of a software company, one in the sea of many, I will say, innovation will happen when the phones get off the hook form highly demanding end users who want to make sure the MU is met and a Government Final Ruling that will get Government out of Development. Government is a terrible manufacture of innovation. One other major issue is that the end users don’t really want to pay for the innovation, if the EHR is working they are happy with the LOB application. That in and off itself is a issue, new features don’t translate to higher fees, the opposite is the case, less features in a Free Package can be much more attractive as both meet the basic LOB requirements.

We are the US, as much as the rest of the world tries, inguinity is what makes us great, our leading export, but in this vertical it is all but dead.

Catherine Huddle offered this insight about MU not just derailing EHR development innovation, but also possibly making things worse:

As for MU, as an EHR vendor I would agree that it and related government programs such as PQRS and PCMH have significantly derailed most other product development. Not only was Stage 2 a development “hog” but it brought in required changes that are often unnatural in a practice’s workflow and overly complicated.

MU has changed the goal from delivering what providers need to finding the best way to deliver MU to make it easiest for the providers and other staff – while still trying to make other improvements to the EHR. Unless the government repeals MU and the Medicare penalties the winning EHRs will be the ones that make MU as easy as possible.

While there’s plenty to be pessimistic about what’s happened with EHR, I’m still optimistic that we’ve passed through the meaningful use waters and that the future will bring forth opportunity for EHR development innovation. I’m hopeful (although not 100% certain) that the people in Washington have seen the toll that meaningful use has paid on the industry and they’ll lighten the load so that EHR vendors can start listening to end users instead of regulators.

July 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

The Meaningful Use Revolution

Meaningful Use change is afoot in the world of EHR software. Many doctors, hospitals and EHR vendors were set up to step away from meaningful use stage 2. Many would have filed for an exception, others would have opted out of Medicare, and others would have just taken the penalties on the chin. It wouldn’t have been pretty and the people at CMS/ONC/HHS realized this was happening and had to do something to avoid the meaningful use stage 2 fall out. It wouldn’t have looked good to have billions of dollars of EHR incentive money sitting on the table with no one wanting it.

CMS decided to cover this wound with a bandaid fix that essentially delays meaningful use stage 2. There are still a lot of details of the proposed rule that are unclear. For example, can anyone attest to meaningful use stage 1 or is that option only available to those EHR vendors who aren’t ready for meaningful use stage 2? I’ve sent that question to CMS, but still haven’t gotten an answer.

Can you imagine the fallout if this is indeed the case? Basically they’d be saying, “All of you EHR vendors and organizations that were good and stayed up with the latest regulations are going to have to do more work and attest to the stricter MU2 criteria while we reward those EHR vendors and organizations that weren’t ready for MU2 with a simpler option.” Can you imagine the backlash that would occur if this is indeed what they decide to do? For that reason alone, I can’t imagine them keeping it that way. I think they have to just open up all the stages/certifications to anyone and everyone regardless of your EHR vendor’s readiness for MU2. (Note: I haven’t dug in to see if this is really a viable option or if a 2014 Certified EHR required changes to the software which make it so it can’t do both MU2 and MU1, but I think it should work out fine. For example, CQMs are tied to certification year and not MU stage. Update: Lynn Scheps from SRSSoft sent me the following update “Prior to the publication of the proposed rule, 2014 CEHRT was required for everyone who wanted to earn an incentive in 2014, so part of the certification requirements was that the EHR could be used for stage 1 or stage 2.”)

What’s even more important is that this is really just the start of the meaningful use revolution. I’ve pointed out my article to “blow up meaningful use” a few times before and that message is starting to be shared by other healthcare IT influencers. For example, the title of this post came from a post by EHR certification and Meaningful Use expert, Jim Tate’s post “You Say You Want a Meaningful Use Revolution” which was a great follow up to his “Meaningful Use Zombie Land” post.

It has become really clear that there’s a lot of confusion afoot. The thing people want most from government regulation is clarity and ICD-10 and now meaningful use are suffering from a lack of clarity. John Halamka summarizes this issue really well:

at some point we need to recognize that layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity. I have direct access to the authors of the regulations and email them on a daily basis. It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers. I realize that we are reaching the end of the stimulus dollars, but as we head into Stage 3, I wonder if we can radically simplify the program, focusing on a few key policy goals such as interoperability, eliminating most of the existing certification requirements, and giving very clear direction to hospitals and professionals as to what must be done when.

I’m glad to see that John Halamka and myself are on the same page. We need to simplify meaningful use and focus on interoperability. That’s a simple and clear message that providers will understand. I was excited that EHR vendor athenahealth offered a similar view in their post “We Should Be Pushing Interoperability Boundaries, Not EHR Certification Timelines.”

Jim Tate has a good call to action to those who care about what’s happening with meaningful use. As of last night, only 8 comments had been made during the public comment period for the meaningful use stage 2 delay NPRM. You can submit your comments on the rule incredibly easy at the following link: http://www.regulations.gov/#!documentDetail;D=CMS-2014-0064-0002 I’ll be taking this post and my “blowing up meaningful use” and modifying them as my comments. I hope you’ll take the time and share your thoughts on the delay and the future of meaningful use.

May 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

TrueMU – When You Realize the MU Standards Are Too Low

I’ve been writing about meaningful use a lot lately and the path forward for meaningful use. You may want to check out my post about Meaningful Use Being On the Ropes as one example. Although, even more important is this post about how meaningful use missed the patient engagement opportunity. Plus, my next post on LinkedIn is going to be about blowing up meaningful use.

In some ways, people are looking at what I write as a call to dumb down meaningful use. I don’t think that’s what I’m trying to do at all. I don’t think we should lower our standards of what we expect to get from EHR software. I just think that we should make it more meaningful. That’s why the example of patient engagement is an important one. A slight tweak to the meaningful use requirements and we’d actually get more patient engagement out of meaningful use for the same price.

I saw a great example of what I want to achieve in something called TrueMU by HelioMetrics. I think this line from their page says a lot:

“Healthcare providers are achieving Meaningful Use and realizing that standards are lower than the goals that they would like to set for their organizations.”

One of the problems with setting an expectation for people is that they then often go into default mode and just try to meet the expectation. This is happening with meaningful use. People see that as the standard they need to meet to be updated in their use of technology. If this artificial bar weren’t there, many of them would strive for even higher results.

The great part is that we can recognize this and fix it. We can think more strategically in how we’re using technology and achieve well beyond what’s defined in meaningful use. We just have to strategically make this part of our thinking.

I actually saw a lot of this happening with ICD-10. Many organizations saw ICD-10 and didn’t just choose to organize around trying to meet the ICD-10 standard. Instead, they created entire clinical documentation improvement (CDI) programs that would improve the quality of their documentation regardless of which standard they chose to use (or in this case chose to delay).

I wonder what results organizations are seeing when they stop focusing so much on meaningful use and instead focus on ways technology and EHR software can improve their organizations. If you have a story like this, I’d love to hear it.

May 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use is On the Ropes

We’re entering a really interesting and challenging time when it comes to meaningful use. We’ve often wrote about the inverse relationship between incentive and requirements that exists with meaningful use. As meaningful use stage 2 is now becoming a reality for many organizations and EHR vendors, the backlash against it is really starting to heat up.

If you don’t think this is the case, this slide from the HIT Policy Committee presentation says it a lot when it comes to organizations’ view of meaningful use stage 2.

Meaningful Use Stage 2 Attesatation - May 2014

For those that can’t believe what they’re reading, you’re reading it right. 4 hospitals have attested to meaningful use stage 2 and 50 providers as of May 1st. Certainly it’s still relatively early for meaningful use stage 2, but these numbers provide a stark contrast when you think about the early rush to get EHR incentive money during meaningful use stage 1.

This article by Healthcare IT News goes into many of the strains that were seen in the HIT Policy Committee. Sounded like the healthcare IT version of Real Housewives. However, the point they’re discussing are really important and people on both sides have some really strong opinions.

My favorite quote is this one in reply to the idea that we don’t need EHR certification at this point: “Deputy national coordinator Jacob Reider, MD, disagreed. Ongoing certification is required to give physicians and hospitals the security they need when purchasing products.”

Looks like he stole that line from CCHIT (see also this one). What security and assurance does EHR Certification provide the end user? The idea is just so terribly flawed. The only assurance and security someone feels buying a certified EHR is that they can get the EHR ID number off the ONC-CHPL when they apply for the EHR incentive money. The EHR certification can’t even certify EHR to a standard so that they can share health data. EHR Certification should go away.

I’m also a huge fan of the movement in that committee to simplify and strip out the complexity of meaningful use. I wish they’d strip it down to just interoperability. Then, the numbers above would change dramatically. Although, I’ve learned that the legislation won’t let them go that simple. For example, the legislation requires that they include quality measures.

No matter which way they go, I think meaningful use is in a tenuous situation. It’s indeed on the ropes. It hasn’t quite fallen to the mat yet, but it might soon if something dramatic doesn’t happen to simplify it.

May 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EHR Post Acquisition, 2014 Certified, ICD-10 and the Amazing Charts Future with John Squire, President and COO

I had the chance to sit down and interview John Squire, President and COO of Amazing Charts. I was interested to learn about the transition Amazing Charts has experienced after being purchased by Pri-Med and the departure of Amazing Charts Founder, Jonathan Bertman. Plus, I wanted to learn why Amazing Charts wasn’t yet 2014 Certified and their plans to make it a reality. We also talk about the value of meaningful use and the ICD-10 delay. Then, we wrap up with a look at where Amazing Charts is headed in the future.

Check out EHR videos for all of my EHR and Healthcare IT interview videos and be sure to subscribe to the Healthcare Scene youtube channel.

April 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

The Time Has Finally Come for MU, It Really Is Now or Never

The following is a guest blog post by Lea Chatham.
Lea Chatham

The healthcare industry has been talking about Meaningful Use (MU) for years now. The program started in 2011, but there were discussions and planning going on years before that. It’s become a ubiquitous topic in healthcare publications and blogs. So much so that many providers probably still think that they have time to decide if they are really going to attest or not.

The truth is that 2014 is last year to initiate participation for Medicare to receive incentive payments. To avoid the first adjustment of 1%, providers must attest for Stage 1, Year 1 no later than the third quarter of 2014 (July 1 – September 30, 2014). You can still start MU in future years to avoid additional penalties, but you won’t get any incentives and you will still have the 1% deduction on your Medicare Part B Claims starting in 2015. That penalty doesn’t go away if you start MU in 2015 or 2016.

What this means is that the estimated 40% of America’s physicians who don’t’ have an EHR and haven’t yet begun to attest for MU have a decision to make—now. And there are essentially three options:

  1. Choose an EHR and attest in 2014
  2. Accept the penalty (which increases each year)
  3. Request a hardship exception.

Here is what you need to know about each of these options so you can make the right choice for your practice.

Choose an EHR & Attest

Over $16 billion in incentives has been paid out to providers who have been attesting for MU. If you start in 2014, you’ll still get $24,000 over three years for your efforts. You’ll also avoid the penalties, which start with 1% in 2015 and increase each year for a minimum of three years. The larger your Medicare pool of patients, the more sense this makes financially.

If you are going to adopt an EHR now, be sure to choose the right solution for your needs. Many of the providers who have not yet implemented an EHR, are small practices (10 or fewer providers). According to a survey conducted in January by SK&A, the smaller the practice, the lower the adoption rate. Small, independent practices don’t have staff, time, or money to waste. So it has to be right the first time. Take these factors into consideration:

  1. Cost: There are now free and low cost EHRs that can offer almost any specialty the tools they need to reap the benefits of an EHR.
  2. Cloud-based and Mobile: Its 2014, don’t choose an EHR unless it offers anytime, anywhere access and true mobile connectivity.
  3. 2014 Edition Certified for MU: As of January 1, 2014, you need a 2014 Edition certified EHR to attest for MU. Only about 12% of complete EHRs have this certification, which narrows the field.
  4. Total Integration: You can get more from your EHR if it is fully integrated with your practice management and billing system. You can meet MU and streamline many other functions. As a bonus it can actually increase both charges and collections. A UBM white paper showed that the average increase in revenue was $33,000 per FTE provider per year!

Accept the Penalty

So you are thinking you’ll just take the penalty. This may be because you don’t serve Medicare patients or at least not that many. It could also be that you are planning to retire soon and don’t think you’ll be around in another couple of years. But consider this, with MU, PQRS, and eRx penalties, it reaches over 10% in total adjustments to your Medicare Part B claims in five years. If you do start seeing more Medicare patients (as your patients age) or you don’t retire, 10% is nothing to sneeze at. If you are a solo doc and you generate an average of $30,000 a month and about 30% of your patients have Medicare, that’s $10,000 a month. A 10% cut adds up to $12,000 a year. To make that up, you would have to conduct about 100-120 more patient visits a year (if your average visit reimbursement is around $100-150).

And here is something else to consider. Perhaps you are willing to take that hit, and you are sure that you don’t want to attest for MU. But does that mean you don’t need to implement an EHR? Not these days. Patient expectations are changing, and to stay competitive you need to meet those expectations. A study conducted by the Optum Institute showed that 62% of patients want to correspond with their physician online and 75% are willing to view their medical records online. Another survey conducted by Deloitte showed that two-thirds of patient would consider switching to a physician who offers secure access to medical records online. You need patients to stay in business so take their changing needs seriously or you may struggle to stay competitive in changing times.

Request a Hardship Exception

The first thing that needs to be said here is that not everyone can apply for a hardship exception. If you’d like to attest for MU, but need more time AND you meet one or more of the criteria, then you should definitely consider this option. This is a summary, check the CMS tipsheet to find out more:

  1. Your area lacks the necessary infrastructure (i.e., no broadband)
  2. You’re a new provider
  3. Natural disaster or other unforeseen barrier
  4. Lack of face-to-face interaction with patients
  5. Practice in multiple locations
  6. EHR vendor issues (i.e., your current vendor was unable to certify for 2014 edition)

For most providers who are practicing full time in a single location and have not yet chosen an EHR, these exceptions won’t apply. This leaves you with choices and one and two above. You will still need to decide if you want to attest or not.

If you are still on the fence, consider this… Beyond MU, practices are facing the ICD-10 transition and a changing reimbursement landscape with ongoing reform from of the Affordable Care Act (ACA). Technology can be a very effective tool to help you manage these changes and turn this set of challenges into an opportunity to optimize your practice and position your business for success no matter what comes your way.


About Lea Chatham

Lea Chatham is the Content Expert at Kareo, responsible for developing educational resources to help small medical practices improve their businesses. She joined Kareo after working at a small integrated health system for over five years developing marketing and educational tools and events for patients. Prior to that, Lea was a marketing coordinator for Medical Manager Health Systems, WebMD Practice Services, Emdeon, and Sage Software. She specializes in simplifying information about healthcare and healthcare technology for physicians, practice staff, and patients.

March 27, 2014 I Written By

CMS Adds Vendor Unreadiness To Meaningful Use Hardship Exemptions

After watching providers struggle to get their vendors in line for the next round of attestations, CMS has decided to give hospitals a break where vendor unreadiness is concerned in meeting Stage 2 Meaningful Use requirements.

Until recently, lack of infrastructure and unforeseen or uncontrollable circumstances were the only criteria CMS would consider in granting hardship exemptions to providers struggling with reading Stage 2 requirements.

Now, CMS has taken a new step demonstrating that it understands that EMR vendors are not up to speed many cases. CMS has added “2014 EHR vendor issues” as an acceptable reason to receive a hardship exemption to Stage 2 requirements.

To qualify for this exemption, the hospital’s EHR vendor must have been unable to obtain 2014 certification of the hospital was unable to implement Meaningful  Use due to 2014 EHR certification delays. According to the form required to apply for this exemption, “circumstances must be beyond the Hospital’s control and the Hospital must explicitly outline of the circumstances significantly impaired the Hospital’s ability to meet Meaningful Use.”

CMS has also offered additional hardship exemptions to eligible professionals. Eligible professionals can use “lack of control over the availability of Certified EHR Technology” and “lack of Face-to-Face interaction” as well as EHR vendor issues lack of infrastructure and unforeseen/uncontrollable circumstances.

The expansion of hardship exemptions follows a letter that was sent by six Republican senators last week to CMS requesting clarification of the qualification criteria for the hardship program. The Senators, in their letter, asked CMS how hardship categories might be expanded.

As I see it, it’s good to give providers a break under these circumstances, as they can hardly control whether their vendors have their act together. The question is, how long can CMS continue to give providers and vendors exemptions without undermining their larger policy goals?

March 11, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Meaningful Use Changes Focus to a To-Do List and Away from Patient Care

I was reading a message from a doctor recently that really struck me. He commented about the impact of meaningful use on his EHR use and said that he’s now “trying to figure out what to do next instead of trying to figure out what is wrong with a patient.”

I’m sure some doctors will come on here and argue why the person experiencing this is a bad doctor and why they should always be focused on patient care and not checking the next box. While there’s always a balance in everything we do, the comment from this doctor really struck me because it describes really well the way so many doctors are being trained to use their EHR. They literally have people auditing and tracking them to make sure that they’re checking the right check boxes so they can meet meaningful use. This type of hyper focus on checking the right boxes and punishment when you don’t changes the way someone practices medicine.

I always love when people comment that many doctors didn’t like the stethoscope when it came out. They use that story to explain that many doctors don’t like EHR software, but that they’ll come around the way they did with the stethoscope.

While there’s some merit in this analogy, I can’t imagine there was anyone watching how a doctor used the stethoscope to ensure that it was used in a specific manner. That’s what we have going on in the EHR world today. Meaningful use is so prescriptive in its requirements that it overwhelms a doctor to the point of affecting the quality of care they provide.

Think about the efforts that are being made by EHR vendors and EHR consultants to take the meaningful use load off of a doctor’s back. Everything from changing the design to meet the MU requirements without a major change to workflow to offloading as much of the meaningful use requirements to someone other than the doctor. If meaningful use really was of value for doctors, why would they have to go to all this effort to avoid doing it?

March 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use Payouts Hit $19 Billion

The pace of meaningful use payouts has stayed strong of late, with CMS disclosing that it has disbursed more than $19 billion in EMR usage incentives. While hospitals have been particularly prone to stay on the meaningful use train, eligible providers are collecting their payouts too, according to Healthcare IT News.

According to CMS data, there were 440,998 registered providers participating in the federal EMR incentive program as of the end of 2013, who have to date received 19.2 billion in incentives.

About 88 percent of all eligible hospitals have been given EMR incentive payment so far, according to CMS officials.  Also, about 60 percent of Medicare eligible providers are meaningful users of EMRs, the agency reports.

And the meaningful use programs for Medicare and Medicaid are both active, with more than 340,000 eligible providers having received an incentive payments to their program. Medicaid eligible providers are distinctly less likely to be involved in the meaningful use program; only 20 percent of Medicaid EP’s are meaningful users.

What the Healthcare IT News article doesn’t discuss, but ought to, is that there is considerable evidence that many doctors are not willing to push beyond Stage 1 of meaningful use. Stats suggest that these doctors have little financial incentive to move ahead with Stage 2, and can’t afford the time or money to push through the MU 2 obstacles.

In other words, before CMS runs a victory lap, it might do well to see what’s happening with the doctors walking away from the program.

February 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.