Issues from the Field: Challenges with Meaningful Use

In early May 2013, Dr. Steven Stack, Chair, Board of Trustees for the AMA, testified on concerns about the Meaningful Use program and did an excellent job of  presenting important issues regarding usability, coding, documentation, and lack of flexibility in the Meaningful Use program. Some of these issues were also covered in prior AmericanEHR blogs. Over the past couple of months, several additional issues have been repeatedly shared with ACP staff by physicians regarding the EHR Incentive Program (Meaningful Use). Thomson Kuhn, Senior Systems Architect at ACP and I put together a summary of these concerns and welcome your feedback:

  1. Meaningful Use is not working as well as it could because the technologies required to adequately and efficiently meet the measures are: a) too immature, b) poorly integrated into existing systems, and c) require work flow modifications that interrupt and/or distract from patient care.
  2. MU requirements do not take into account the practice changes that are required, the indirect costs associated with those changes, and the unintended consequences of such changes on patient care due to the focus on MU measures by both practices and vendors.
  3. The lockstep alignment of certification with implementation is related to the perceived lack of usability, inefficiency, and the diminishing satisfaction with EHRs. New features/functions are “bolted on” without appropriate testing prior to implementation.
  4. The all-or-none requirements to achieve the EHR incentive place tremendous pressure on practices (and vendors) to focus on satisfying the MU objectives/measures to the potential exclusion of creating innovative uses of EHRs to achieve the actual intended goals of improving quality and value.
  5. Interoperability is not available at reasonable costs to practices. Proprietary barriers, additional costs, and the fact that there is no pressure to eliminate these barriers by ONC will continue to limit the value of EHRs in transitions of care, information sharing, and creation of the PCMH/PCMH Neighborhood. Most vendors are currently charging EPs for each connection and interface above and beyond the price of the technology even when those interfaces have previously been built and tested. This results in significant, unanticipated expenses for practices trying to meet MU objectives.
  6. There will inevitably be consolidation in the EHR market, which raises several concerns, including:
    • Migration of data: the costs incurred by EPs to switch EHRs can be extraordinary.
    • Switching EHRs during a MU reporting period introduces major challenges with one EHR phasing out and another being implemented; satisfying MU could require maintaining both systems in order to meet reporting obligations.
  7. The currently certified systems are not able to document MU activity in ways that are satisfactory to auditors without significant additional work by the practices to gather the required information such as screen shots with the EHR logo. The requirements for the audit are not included in the current certification requirements for CEHRT.
  8. While physicians, in general, support many of the EHR features/functions advanced by consumer and patient groups, many expectations go well beyond the current capability of systems and practices to efficiently and effectively implement the existing requirements. Further, there are costs that go well beyond the monetary expense of implementation. Using the limited bandwidth of most practices to achieve these goals means less time and effort available for other potentially more fundamental and evidence-based processes. Further, the call for new features and functions continues without any experience or data to support the effectiveness of prior requirements.

What else? What challenges are you having with Meaningful Use? What remedies would you suggest?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP).


8 responses to "Issues from the Field: Challenges with Meaningful Use"
  • June 2, 2013

    I like your information

  • June 18, 2013
    Mike Soppet

    Dr. Michael Barr’s comments accurately reflect the experience we have had in implementing a certified EHR. Most of the meaningful use functionality does indeed seem to be “bolted on” to some existing platform and does not “talk to” or integrate data into the original EHR system.

  • June 18, 2013
    Brian Loftus, MD

    You left out that many of the meaningful use criteria are fairly meaningless.

  • June 18, 2013
    David Shulan

    Agree with the above. We have qualified for stage 1, stage 2 will be more difficult including finding appropriate clinical quality measures, engaging patients to use patient portals.

  • June 18, 2013

    I agree with all of these. The tacked on MU measures to our EMR are just a joke. Hardly meaningful because of the barriers noted above.

  • June 19, 2013

    While EHR’s do appear to be of benefit to the patient and can reduce liability for the physician I agree that the (imposed) rush for MU by incentive payments have indeed limited what a “free market place” would have allowed to develop.
    Being pushed into compliance with incentives and then with CMS reduction in reimbursement penalties is not in step with a free market economy and limits creativity…which, instead, should be encouraged and developed!
    In the future the number of available EHR’s for use should diminish with surviving programs coming from companies that have positioned themselves close to government MU regulators.
    Imagine what kind of cars would have come out of Detroit if built with such government directives!

  • July 19, 2013

    Good point, KC! While the motives are good and noble, having the Federal Government in the middle of this will almost certainly result in a poor “final product”. The difficulties in getting systems to “talk” to each other is an enormous problem and will definitely overshadow many of the positives that having individual providers/facilities can bring If the systems can’t talk to each other and share information easily, the benefits will simply not be there.

  • September 12, 2013
    Andrew Bone

    Stage 2 Clinical Summaries must have patient problem lists, Gender, race and ethnicity along with the documented smoking status.
    Do these seem like ridiculous things to mandate in the Clinical summary. I believe a patient knows their smoking status and they certainly do not need a document telling them their race and ethnicity.

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