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If Meaningful Use Were Gone – Perspective from EHR Executive at Modernizing Medicine

Posted on February 3, 2014 I Written By

The following is a guest blog post by Michael Sherling, MD, in response to the question I posed in my “State of the Meaningful Use” call to action.

If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?

Michael Sherling
Michael Sherling, MD, MBA
Chief Medical Officer and Co-Founder, Modernizing Medicine

What a great question! As both the co-founder of Modernizing Medicine, and a practicing dermatologist that uses EMA, I can appreciate the amount of time and effort it goes into developing MU feature sets, as well as inputting the data in to be a “meaningful user.”

The Top 3 Measures I would remove

  1. Clinical Summaries Provided to Patient
  2. Vital Signs
  3. Clinical Quality Measures

I understand the intent for patients to receive clinical summaries of each visit- but this places an incredible burden on the end user (physicians and office staff) to make sure that each patient has access to their clinical summaries.  For instance, even though we live in the digital age, several of my older patients don’t own a computer or have access to one.  Additionally, these summaries lead to more questions by the patients after the visit has been concluded often times regarding details of the summary that are relatively innocuous.

I have a serious beef with government mandating of Vital Signs.  Health care providers know when it is medically necessary to take vital signs and when it is not.  Those who never take vital signs, because it is unrelated to their scope of practice can claim exceptions, but those who take a few are often stuck between their medical responsibilities and getting an incentive.  In the end, these dermatologists and ophthalmologists wind up taking more blood pressures or measuring the height and weight of their patients unnecessarily to achieve the incentive.  This paradoxically is medically meaningless since dermatologists don’t treat blood pressure, and ophthalmologists don’t often dose weight-based drugs (they like eye drops).

Clinical Quality Measures needs to be renamed to Cost Effective Measures.   Clearly, the goal of CQM is to change physician behavior so that physician decisions are more cost effective.  This is needed in our health care system.  What today is an incentive based on pay for reporting, will be transformed to pay for performance tomorrow.  My concern as a physician is how do we know these are the right questions to ask?  If physicians comply with these CQM guidelines, will that result in not just lower costs, but more effective care?  I’d much rather see benchmarking around actual patient clinical outcomes themselves, using tools like static global assessments of disease rather than a questionnaire about whether or not I followed a recipe for how a committee thinks I should treat every patient with condition Y.

The Top 5 Measures I would Keep

  1. Electronic Prescribing
  2. Medication List
  3. Allergy List
  4. Drug-Drug, Drug-Allergy Interaction Checks
  5. Patient Search

All of these measures are critical to patient care and have obvious benefits.  With electronic prescribing, prescription orders are standardized and LEGIBLE! No need for the pharmacist to discern my own poor doctor handwriting anymore.   Keeping the medication and allergy lists updated and the drug-drug and drug-allergy checks enabled makes for great patient care.  No physician wants to prescribe a medication that interacts with another in a negative way, nor do we want to prescribe a medication that could potentially cross-react with a known allergy. Finally, patient search is a really cool feature that allows all of us to search for patients with specific diseases and medications. This is an important first step in getting records to behave more like research databases for clinical studies and less like word-processors for just note taking.

NIST EHR Certification Test Plan

Posted on March 28, 2010 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I posted on my other site about the NIST EHR Certification testing website. I still haven’t had much time to dig deep into what’s available, but one of my readers sent me the following (excuse the lack of form since they probably didn’t intend it to be published):

Boy, I don’t know what to think. Much of this seems to be piles of words referring to zillions of links.

However, I did find a place where it talks about the “Draft Test Procedures.” Under that heading it lists the “Draft Test Method” for a category such as Maintain Active Medication List. It shows, for instance, that you must be able to enter something like:

RxNormCode Medication Brand Name (generic name) Dose Form Route Frequency DateStarted DateStopped
205875 Diabeta (glyburide) 2.5 mg Tablet By mouth(po) every morning 9/16/09
617314 Lipitor (atorvastatin calcium) 10 mg Tablet By mouth(po) daily 5/5/08

and then modify, and later list. So, I guess if a system didn’t have the ability to enter “route” then does this mean the system fails? Or, does allowing an improper form of “route” for the med make it fail? Unclear. On the other hand, because you can enter and modify all of the above, does it “pass”? What is missing, from my opinion, is the useability factor. My docs, for instance, like to see the history of dispensing of a given medication. Knowing and being able to easily see the various dispensings of amoxicillin is key to practicing good medicine. The Draft does not address that and is, in my opinion, a major missing point. One can have a system where doing anything takes lots of clicks and typing, or common things can be done in a few steps.

The rest of the Draft Test Methods are the same. Enter this, change that, make a list.

It would be nice if someone could tell me what it is I’m missing.

Does anyone else get the feeling that this certification stuff is going to be a mess and add little value for doctors?