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Thinking About Meaningful Use?

Thinking About Meaningful Use?

Those with their ears close to the “policy ground” (or those who have seen official announcements from ONC) know to expect the Meaningful Use Stage 2 Notice of Proposed Rule Making (NPRM) any day now.  But that’s not what I am referring to.  Not that there won’t be a lot of thinking (and discussion, and writing) – but I believe that will mostly, if not exclusively, be reactive, with responses such as “the rule asks for action on x% of patients with a particular condition, and we believe that is too difficult for most providers to achieve – so we ask for x minus 10%…”  And to be clear, this level of analysis and response from individuals and organizations is absolutely necessary – and you will see it on this site as well. But I am looking for more.  

One of the co-founders of Doctors Helping Doctors, Michael Zaroukian, and I have been asked to do a presentation at the American College of Physicians’ annual meeting in April, titled “Finding Meaning in Meaningful Use.”  Within this presentation, Dr. Z and I will ask our audience to consider “finding meaning” to be more than just being successful and receiving a check, but also actively engaging as thoughtful professionals seeing patients, and reflecting on the following:  “What have I been doing differently since I started using an EHR and striving for success with one or Meaningful Use metrics?”  Aside from the challenges and discomfort with changing processes and/or getting used to new technology, we hope that physicians will ask themselves the following:

  • Do I feel that attempting to satisfy the metric moved me closer to the objective?
  • Do I feel that attempting to satisfy the metric moved me further from the objective?
  • Has my focus (and that of my colleagues and the industry) led to improvement in the underlying processes that need improvement; the enabling health IT infrastructure that needs improvement?

Let me move the above questions from the theoretical to a very practical question, and one that is likely to be re-addressed in a Stage 2 metric – ePrescribing.  While the history of ePrescribing contains a lot of interesting side stories, its primary reason for being is to provide a vehicle to make prescribing better and safer (reduce or eliminate errors in legibility, translation, dosing, etc.).  And because of its evolution and the industries that brought us ePrescribing, it also now contains other key information related to value and quality (such as eligibility, formulary, medication history, fill history, etc.) 

The Stage 1 Meaningful Use metric for ePrescribing was “40%+ of eligible prescriptions are created and sent electronically.”  In the interests of full disclosure, at the time the Stage 1 NPRM came out, I argued strongly for reducing the percentage to 25%.  Coincidentally, that was about the level of ePrescribing that my health system was achieving then, after being up on ePrescribing for about a year.  The counter argument to mine, “one of the purposes of Meaningful Use is to provide something that is now out of reach for current practice, but within reach for most if we push ourselves a bit; it will also push the industry to make ePrescribing better.”  And 18 months later, while there are some providers in my health system who did not improve their rates of ePrescribing to above the 40% threshold, most did, and as a system, we are now at ~ 65%.  So I was proven wrong.  

Not so fast…  The title of this post is “thinking about Meaningful Use,” and I am thinking right now – yes, we got hundreds of providers to start using ePrescribing and using it consistently (which is a good thing, and BTW for the most part, patients find it very convenient) – but has this rapid ramp up in ePrescribing led to improved medication safety and value?  Has it stimulated the market to make ePrescribing better?  The quick answers – not sure, and no.

About Peter Basch, MD

Medical Director, Ambulatory EHR and Health Information Technology Policy
MedStar Health

Washington, DC

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