When physicians ask me why they should embark on the difficult task of becoming ‘meaningful users’ of electronic health record (EHR) systems, this is how I tend to start and finish my answer. This prioritization of the patient’s needs is at the heart of our work as physicians and it aligns us with the vision and mission statements of hospitals and practices that have been nationally recognized for health care quality and value. It drives and sustains our willingness to work together to provide the best care and experience for our patients and families. It explains why we endured years of long hours of training that were determined first by our patients’ needs rather than a time clock. It motivates our commitment to lifelong learning, our sharing of our expertise with others, and our curiosity for finding better ways to combine people, processes, and technologies to improve patient outcomes and satisfaction.
That the patient’s needs matter most and come first also helps explain why physicians like me are sharing our knowledge and experiences in EHR adoption and meaningful use on the Doctors Helping Doctors Transform Health Care web site. Our motivation to use EHRs in a way that is consistent with what the Office of the National Coordinator (ONC) for Health Information Technology and the Centers for Medicare and Medicaid Services (CMS) have defined as a ‘meaningful use’ does not come from a geeky enthusiasm about computers in general but rather because our experiences adopting and using EHRs (e.g., my own clinic) have yielded important improvements in care quality, efficiency, value and satisfaction. We are here to share our stories and help each other transform a broken health care system to improve quality and value, with EHRs and health IT as essential enabling technologies.
The story I will share here involves a presentation I gave to a national surgical specialty society in response to a request to help its members understand the rationale for health IT use and to find meaning in the CMS Meaningful Use Incentive Program. The background information I received reflected the view that the meaningful use measures (MUMs) and clinical quality measures (CQMs) were too often irrelevant to their specialty or too difficult to achieve in the near term. Indeed, in their official response to the Notice of Proposed Rule-Making (NPRM), their three big ‘asks’ included, 1) reducing the number of measures that must be met; 2) modifying the measures to reflect the differences in what is meaningful across different specialties; and 3) allowing flexibility to select measures that best fit their practice environment.
My goal was to compare the Meaningful Use Final Rule with the specialty society’s response letter to the Proposed Rule, assessing and reporting the extent to which their feedback produced a favorable response, and discussing next steps for those who were willing to strive to become meaningful EHR users. I started by showing them that the changes in the Final Rule were at least somewhat responsive to their three big ‘asks’, in that it reduced the number (from 25 to 20) of MUMs that must be met; 2) allowed for exclusions for up to 12 of the 25 MUMs if an eligible professional (EP) could demonstrate that they were irrelevant; and 3) allowing for flexibility in the selection of certain MUMs and CQMs.
For each MUM, I also used a visual framework (the Wong-Baker FACES pain scale) used regularly in their practices to present the results of my analysis (Figure). Happy faces signified a change in the Final Rule that I felt was significantly responsive to their feedback, a neutral face for a change that was responsive but unlikely to be seen as much improved, and an unhappy face where a major concern was not met with a clearly favorable change.
The direct feedback I received during and after the presentation was that my analysis and report had helped physicians realize that their concerns and requests had been heard and significantly responded to. Some also verbalized a greater interest in helping other physicians take next steps in achieving meaningful use in their practices.
The remainder of my presentation focused on the “10 Steps to Securing the Federal EHR Incentive Payment for Ambulatory Practitioners” (access requires HIMSS membership). This document provides specific guidance on the steps physicians should take to participate in the CMS Meaningful Use program. I also discussed how providers and office staff can work together to capture and share data to improve quality and qualify for meaningful use incentive payments (Figure).
While this story illustrates one approach to helping physicians find meaning in meaningful use, it represents only one part of the complex change required to transform care quality and value using EHR systems and health IT. Physicians have very busy lives and change is hard. However, they also increasingly realize that our health care delivery system must change and that EHRs will be an important part of that change. The consequences of failure to recognize and respond for the need to change are well summarized in the words of noted management expert W. Edwards Deming: “It is not necessary to change. Survival is not mandatory.”
In a future blog, I will talk more about the challenges of change and how they can be successfully overcome. For those who want to be among the very best, it helps to have a correct principle that everyone believes in. For me, that principle is:
The patient’s needs matter most and come first.