Wednesday, July 14, 2010

Thoughts about the final "meaningful use" rules

The final "meaningful use" rules came out yesterday. I'm still reading through the 800 page document and thinking about the amount of time it must have taken to come up with all these rules. The New England Journal of Medicine (NEJM) published a perspective article yesterday titled, "The “Meaningful Use” Regulation for Electronic Health Records." David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A. start the article with this paragraph:
The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice. 
They then remind the readers that:
Through HITECH, the federal government will commit unprecedented  resources to supporting the adoption and use of EHRs. It will  make available incentive payments totaling up to $27 billion  over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. This funding will provide important support to achieve liftoff for the creation of a nationwide system of EHRs.
That's a lot of money, but will it be adequate to ensure that hospitals and physicians are equipped with the support staff and the IT infrastructure to achieve "meaningful use" within their organizations?

Healthcare IT News is reporting that "Overall, AHA leaders said they remain concerned that the requirements may be out of reach for many hospitals. "Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption," AHA said in its statement."
 So, what do you think about these "meaningful use" rules? Are they still contain too many administrative burdens? Will the implementation of EHRs lead to improved patient care if providers are too caught up worrying about "meaningful use" instead of focusing on clinical outcomes? Will we see an increase in medical errors as hospitals rush to implement Computerized Provider Order Entry (CPOE) systems when they're not adequately prepared? What about rural hospitals? Will they receive the support they need to achieve "meaningful use" and will they even qualify for the financial incentives outlined in the HITECH Act?

In my experience, the "average" physician who's currently in practice is not very tech-savvy. Then again, the definition of "tech-savvy" seems to constantly evolve as the bar gets higher each year. How about nurses and pharmacists? Who will ultimately be held responsible to ensure that hospitals are achieving "meaningful use?"

I know that some physicians won't even bother to try to achieve "meaningful use" because they don't believe that they will ever see any of those financial incentives. The sad reality is that too many physicians have lost faith in Medicare and Medicaid. They never received any incentives for using e-Prescribing. They simply don't believe that the government has the infrastructure to monitor the use of EHRs and effectively determine whether physicians or hospitals are achieving "meaningful use."

The transition from paper to electronic records won't be easy and many physicians and hospitals will struggle as they encounter technical problems, computer glitches, bugs, workflow issues, etc.  Hopefully we'll see many new jobs opening up as the health IT industry explodes in the United States.

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