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Screwed Up Meaningful Use (at least for specialists)

Posted on January 24, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I regularly get passionate emails from readers of EMR and EHR (and of course my other site EMR and HIPAA. I don’t always agree with the emails, but I almost always find them interesting. The following is one such email. It wasn’t intended to be published, so excuse the format. However, I find much of the comments about ONC’s approach to specialists spot on. The hard part is that I think ONC realizes this as well. The question is whether ONC in meaningful use stage 2 is going to do anything to address the specialist problem. I think this is a topic we need to voice to ONC.

The EMR’s basically started with certification requirements from CCHIT…ONC took that starting point…and moved to MU from it…without regard to specialty. Properly done, they should have started with MU by specialty…then figured out what the product certification requirements should be from there—for that specialty: Orthopedic guys see lots of patients (50-70 per day, and lose two days/week to surgery), mostly NEW patients with specific problems (broken bones or joint replacements)…no big longitudinal charts…and need to dictate complex notes; Dermatologists have lots of lab/biopsy tests, need to draw pictures and annotate them, not dictate; Pediatricians need growth charts and long medical histories and trends; Oncologists need detailed treatment histories, dosages, outcomes; Ophthalmologists need lots of technical data, measurements and interfaces to optic devices. Yet ONC made a set of rules that really only apply to Primary Care…which is where much of the CHRONIC conditions (and a large portion of the medical cost issues) are quarterbacked…and have the best chance of prevention.

Besides…all the data from specialists should flow back to the PriCare docs anyway…why try to keep it coordinated in both places? I think we have a long way to go to get all healthcare “communitized”…and powers that be need to recognize how different things are for various specialties…and define MU from each specialty’s point of view…and find out that the current certification standards are WAY overkill for most of them…unnecessary complexity and, thereby, cost….to do the irrelevant things to qualify for incentives. After five years, they will stop doing those things anyway, when incentives run out. Having a data pathway between in-patient and out-patient (ambulatory) is a great goal…that should come first..the ability to share data…even if via documents. That could be done today. Trying to devise interoperability standards for 400 EHR’s, a dozen or so major Hospital-based vendors…and registries, labs and other participants….that is a LONG way from being reality

Will be interesting to see how the “success stories” pan out this year starting in May for EP’s. Thank goodness ONC has made it almost impossibly easy for specialists in Stage I….they can opt out of almost everything required and get incentives the first 2 years($30k)…is that a good use of taxpayer money?

HIT Policy Committee Confronts Meaningful Use and Specialists

Posted on October 27, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Goverment Health IT summarized some of the discussion that happened today at the HIT policy committee meeting which focused on the challenge of applying meaningful use across all of the various specialty groups in healthcare. Here’s some excerpts from the article:

The Health IT Policy Committee today confronted the problem of how to craft a manageable set of requirements for the “meaningful use” of health IT across an industry where specialties and new practice variations are common – and where one policy may not fit all.

Those measures were geared for what is normally a patient’s first encounter with the health system: the primary care physician. But many specialists – who do not treat a wide range of diseases and conditions – may not be able to comply with all the current 2011 [meaningful use] requirements.

“Not all objectives and measures are appropriate for all eligible professionals,” said Paul Tang, vice chairman of the Committee and chief medical information officer at Palo Alto Foundation.

As a result, the committee must decide which of the 25 meaningful use measures should apply to specialists so they still can qualify for 2011 incentive payments – and which requirements to delay introducing til 2013 and 2015.

“I don’t think it was understood that we weren’t intending to have all the measures apply to all specialists,” said Dr. David Blumenthal, the national health IT coordinator.

Unfortunately, I think this discussion has just begun and is going to get more complicated as we go. I know of a number of cases where the MU requirements just don’t make sense to a specialist. However, the challenge will be to have a set of requirements that aren’t so complex that it takes a specialist to be able to understand how the meaningful use requirements apply across the spectrum of doctors in healthcare.

What are your thoughts on how they should apply meaningful use effectively?