Meaningful Use of Electronic Medical Records: A Practical Overview

Posted by: Dr. David Scher, DLS Healthcare Consulting

The legislation commonly known as ‘Obamacare’, the Affordable Care Act, contains requirements and deadlines for the implementation of electronic medical records, collectively known as Meaningful Use (MU).  There are many definite contributions to improved coordination of healthcare that these will realize.  The cost savings and improvement in patient outcome touted by the government remain to be proven. 

Truths

1. MU is expensive.  In one study, the average cost per primary care physician including training time is $47,000.  The maximum government Medicare MU incentive is $43,000. Hospitals on average are spending over $2M on this endeavor.  After 2017, penalties will be assessed for not meeting these incentives, based on a percentage of Medicare billing amounts. It is estimated that the net effect of penalties outweighing incentive payouts will yield the government $600M in income. 
   
   
2. MU’s requirements/deadlines are not in the real world.  The requirements for example of interfacing with labs and other providers cannot be reached in the allotted time because of technical challenges of interoperability among different EHR companies.  MU is divided into three stages.  Stage 1 in progress now and Stage 2 was supposed to start in 2012 but there are many issues for which the date is now in limbo. There are objections by many specialists because the requirements are primary care oriented and difficult for them to meet, as well as technology-limiting issues.
   
   
3. MU will hopefully raise patient awareness about their own medical records, to which they are mandated to have access through patient portals.  This will only come about through public awareness campaigns.  It will create a burden on providers as they are mandated to review the EHR with the patient after each visit.  Emergency rooms and practices are required to furnish the patient with copies of their visits, instructions, and entire medical records in a very short time (ex., entire records need furnished within four business days of request).
   
   
4. There are not enough qualified health information technologists in the country to make this happen as quickly as desired.  Computer programmers are not versed in clinical medicine.  There are six-month courses in healthcare IT but do not prepare them for the required jobs.  A whole generation of specialists in this field needs to come of age.

 

Fallacies

1. This will be completely adopted and will improve healthcare. 
   
   A recent review of the implementation of a national health information exchange in England found that it failed because many patients and physicians opted out of the program due to security concerns and burdensome implementation respectively.  Outcome studies will need to be done to prove EHRs’ clinical benefit.  There are significant obstacles (primarily by physicians) regarding universal adoption of EHRs. The advent of ACOs will be a test of the benefits of EHRs as well.
   
   
2. An EHR system that is ‘certified’ by the CCHIT (the body designated by the ONC or Office of the National Coordinator of the government) has all the qualifications to meet MU.  This ‘certification body’s approval no longer means that the EHR meets all requirements set forth by the government.  The onus is now on the purchase to make sure that those requirements are met.  This means that the purchase needs to be thoroughly versed in MU requirements.
   
   
3. Your EHR automatically talks to that of your hospital, labs, radiology sources, and other healthcare providers, and others.
   
   The exchange of information among these entities is called interoperability, which is the goal of MU.  However, we are a long way off in this regard.  This may incur additional charges from the vendor or the other entity’s IT source.

MU is a daunting project that may ultimately benefit patients.  It may eliminate duplicate testing of patients, improve patient safety by identifying drug-drug interactions and patient allergies quickly, and become a source of patient education.   The time for EHRs is here and they are welcomed for a number of reasons.  The time and content requirements of MU follow the planned course of its creators has already been challenged.  The security of EHRs remains a huge concern.  Let’s get in and observe the ride.

Dr. David Scher was a practicing cardiac electrophysiologist for 20 years with extensive experience as a clinical investigator, reimbursement committee member, and institutional review board chair. He is currently director at DLS HEALTHCARE CONSULTING, LLC with a focus on medical device and mobile health companies. You can reach Dr. Scher at dlschermd@gmail.com or on Twitter at dlschermd.

Comments

[Electronic Medical Records]

This does promote more jobs for the economy. More poeple need to get into the EMR field to learn and understand how the process works so they they can effectively set it up for the doctors and hospitals so they do not have to worry about it

[David Lee Scher,MD]

There are too many people getting into the field now that do not have any clinical perspective and the lack of attention to workflow is leading to adoption failure. So yes there is a need, but they need to be the right people.

[Deena Smith]

I disagree, there is a huge need/market for electronic medical records ...you may say that the costs incurred to train are very expensive but in the end it will cut costs by eliminating the need for paper, ink, toner and all those other physical costs.

[David Lee Scher, MD]

I do not, nor have I ever, that there is no noeed/market for EHRs. I am did not refer to costs of training personnel. They are certainly worth it. What I was stating is that courses are not clinically oriented. I believe that there should be courses in healthcare IT offered by medical schools for providers as well as non-providers. (see http://davidleescher.com/2011/12/13/medical-schools-in-the-healthcare-it-age/).
the point of EHRs has nothing to do with costs of toner or paper. It has to do with costs associated with medical errors, unnecessary duplication of tests, and of improving outcomes.