Monday, May 19, 2014

Meaningful Use--------for Whom ?

Meaningful Use for Whom ?



Some time ago when EHR was fairly new and systems were immature and not user friendly a new term came into existence,  “Meaningful Use”.

At the time I was never impressed with the early user interface, it was clunky and more important not intuitive.  Intuitive systems are designed with a GUI that leads the user to the next step. It also affords a quick learning curve.  I focused on the ‘ethnology’ or the study of the human-machine interface.  The center of that is the human, not the technology, ie. Provider Centered.

Ethnology is hindered when the user is forced to guess where to go next, or find the screen that  he/she needs to perform the next step.  Based upon current average levels of intelligence and reading comprehension (as studied and defined by competent educators), that is at the eigth grade level, with large print, and pictures.

Be that as it may when I heard the term ‘meaningful use’.  I was excited to interpret that term as what I recommended in many blogs and in conversation with HIT and Health Consultants.

My optimism was bashed when MU was defined. Like many I read into the term as something I wanted to occur.  Nothing could have been further from the truth. I am disappointed as well as most providers.  It cost a fortune.  The coming conversion to ICD-10 will accomplish the same end point.

M.U. has turned out to be nothing more than bureaucratic bloat of the worst type, mandated and defined by an agency that was not interested in EHR as useful for users.  Those who desigined it  were focused passively on receiving the data for analytics.  They placed the cart before the horse.  The resulting system is sabotaged by the disinterest, as well as outright hostility by providers and even health consultants. The system was designed by health bureaucrats and pseudo population health experts.   In my day it was called ‘epidemiology”, a term that evaporated in the last two decades. Epidemiology is defined in Wikipedia and the Dictionary. It was subverted and re-defined by HHS and CMS.

When it comes to the topic of meaningful use, Colin Banas, MD, is driven by fear. And he's far from being the only one.

Although several stages have been adopted by providers with some arm twisting and extortion using reward and penalty to incentivize installation of EHRs with MU embedded.  This required expensive alterations to existing EHR systems. Although late in the  game, several medical organizations caution:

Meaningful use has been around for two years. A large number of users have attested to stage I, fewer to stage II and the deadline for stage III is pending. Meaningful use has been a great source for consternation among providers, and a boon to HIT consultants.  It is an expensive journey for provider and hospitals. HHS produced incentives for providers to adopt electronic health records. and penalties for those who would not adopt EHR a penalty. The incentives were inadequate since few providers realized there were 3 stages for meaningful use.  Deadlines are approaching for the implementation of MU and penalties in the form of penalties (reduced reimbursement) are near. ICD-10 deadlines have been extended due to pushback from providers.  This is due to a lack of resources, and the preceeding upgrades of EHR and meaningful use.



In a detailed letter sent to both CMS Administrator Marilyn B. Tavenner and National Coordinator Karen B. DeSalvo, MD, the American Medical Association has put forth a long list of ideas to make meaningful use work better for physicians.

This effort must be joined also by specialty societies, other provider advocate organizations, such as Doctors4PatientCare, the Association of American Physician, The support of these parallel organizations is critical since the AMA represents only 25% of the physicians in the U.S.

It seems just about everybody has a gripe or two concerning the meaningful use program: software vendors that make electronic health records systems, hospital CIOs, the very people charting the related committees and, of course, physicians.

There still remains a lack of a guiding organization with standards of ethnology.  It may exist for other industry IT and record systems, however for health care it is a ‘black hole’.  There are indications that the Food and Drug  Administration is considering EHR as a patient related function and should be included in the FDA’s regulatory arm.  The FDA is well  along with proposals to regulate mobile health apps.

Source:  Meaningful Use Table and Charts for Staging.  (CMS)

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