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Some frank thoughts on Meaningful Use

Meaningful Use is going into its fifth year. Government bureaucrats are bickering over the final rules for MU3 and lawmakers are arguing about the timetable. Staff scrambles to compile reports and data for last-minute 2015 MU2 attestation and we’re all left bemusedly calculating benefits vs. costs

As a health information technology vendor, CaduRx has benefitted from the ONC’s mandate for physicians to adopt electronic medical records. Have the doctors benefitted from Meaningful Use? Have patients?

There are no easy answers: in some ways yes, in others, no. CaduRx believes that in many ways, EMRs have made doctors’ lives easier: no charts to hunt down, web-based access to records, legible notes, active drug-checking for prescriptions, and the ability to manage patient populations have, overall, have helped physicians care for their patients.

But many EMRs are expensive (in terms of cost to purchase / subscribe, cost to train staff, and cost in frustration when they don’t perform as expected). Indeed, many are difficult and time-consuming to use. There’s a reason for that. To stay in business, EMR vendors have to design their products according to complicated ONC specifications in order to be Meaningful Use certified (a very time-consuming and expensive process). CaduRx has chosen to keep its interfaces clean and clutter-free as possible to allow maximum latitude in implementation, which has kept the learning curve gentle and the flexibility optimal. But not all EMR vendors have taken that road, and the result has tended to be complicated, bloated products that are difficult to learn and use.

Although many of the Meaningful Use requirements make some sense and may be pointing the industry in a good direction, they were mostly created by people who don’t see patients every day. Public health wonks, pundits and bureaucrats have designed and forced the Meaningful Use standards into EMR products. A centrally-defined, universally-imposed, one-size-fits-all product born of committee and compromise will never manage to satisfy anyone. Meaningful Use measures may be beneficial to some, meaningless for others. The implementation of these measures by most EMR vendors has been crude and clunky. CaduRx, of course, is an excellent tool in spite of all the interference. Government enforcement is heavy-handed and arrogant. In the long run, Meaningful Use adds up to yet another constraint that stifles innovation for the sake of checking a box instead of caring for the patient (or recording a metric just to report it to Big Brother in order to avoid being penalized).

Even the ONC’s end-user usability requirements for an EMR’s MU certification fail to take into account physician workflow and time constraints. Meeting the usability requirements was really just an exercise in standardized testing for No Child Left Behind—it wasn’t designed to make the EMR easier to use for the physician. But arcane, difficult-to-use systems are familiar territory for caregivers, aren’t they? After all, their payments are adjudicated by bureaucrats who have no knowledge of or interest in patient care. It’s old hat.

The pundits and politicians wonder why the health care system is broken. Delimiting patient encounters to fit canned guidelines and operating within E&M, procedural and diagnostic coding protocols doesn’t produce quality care and can oftentimes impede proper care. Insisting on lockstep adherence to generalized care protocols robs physicians of their ability to act according to their training and to their knowledge of a patient’s unique circumstances and condition. And penalizing physicians for ‘noncompliance’ stifles innovation and treats physicians like naughty schoolchildren who have disobeyed the teacher rather than caring, responsible professionals who have the patient’s best interests at heart.

Likewise, CaduRx would much rather spend its resources on building a tool that is even friendlier, even more efficient and so easy to use as to be seamless to the caregiver’s workflow. We’ve built a good tool in spite of ‘meaningful’ use requirements. We have the intelligence and technology to build an even better tool, but we are constrained by the same sorts of cumbersome regulations and requirements that prevent physicians from optimizing their services.

Wouldn’t it be cool if we had the latitude to create the ultimate tool for physicians and staff? Wouldn’t it be nice if you could practice medicine in a way that aligns with your patient’s unique, individual needs and your personal ideals instead of the generalized top-down guidelines of cookie-cutter medicine?

Could there be another solution? Maybe create a slower, longer, less aggressive implementation schedule? Maybe implement fewer requirements at a time? Perhaps place more emphasis on specialty-specific measures? Allow more flexibility? Trust in the physician’s ability to care for people without incenting and punishing? The power to change lies in the physicians' hands. Ultimately, it’s your industry and it’s your livelihoods and careers. By extension, it’s the health and well-being of America.

If only there were some sort of entity like an association or union that could represent physicians--real physicians--in the implementation of policies designed to improve American health care. If only.

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