Meaningful Use Stage 2: What’s Wrong With This Picture?

It’s been said that a picture is worth a thousand words. The following summary of the proposed regulations for Stage 2 meaningful use and certification says it all—literally and figuratively!

Thanks goes to the Advisory Board Company for reviewing the proposed rules and “simplifying” the requirements for public consumption. (Of course, this poster can be blown up and printed in a readable size . . . if you have 24 square feet of wall space available!) You will see that the requirements for Stage 2 are even more numerous and complex than those for Stage 1. Don’t be fooled by the fact that providers would still have to meet only the same number of measures (20)—many of these measures now have multiple components and subcomponents that incorporate additional requirements that used to be counted as measures in their own right.

Why does meaningful use have to be so complicated and over-specified? How did we go from the original intent of the HITECH Act—encourage EHR adoption to facilitate the three goals of ePrescribing, reporting on quality measures, and exchanging clinical information—to the over-engineered chart above? We have surely lost sight of the forest for the trees.

Physicians cannot be expected to understand the requirements of a program that is so complex that it takes 455 pages to explain. The government is inviting their input on the proposed regulations, but how can busy physicians be expected to comment on a rule that they cannot possibly even have time to read?

I am not denying that the program is the product of a lot of time and hard work on the part of many very smart people who represent the interests of the multitude of stakeholders in the healthcare industry. However, the explosion of requirements is going to frustrate providers and ultimately undermine the success of the entire program, and this is particularly true given the large number of IT-related programs that physicians must comply with now and in the next few years. We have created an administrative nightmare for physicians, and spawned an industry of consultants who are paid by physicians to interpret meaningful use and other complicated incentive programs.

Physicians want to do the right thing—provide better care, improve outcomes, and reduce costs. But they can be pushed only so far before they justifiably start to push back. On March 28, the AMA sent a letter to the Department of Health and Human Services, signed by 61 professional associations and all 51 state medical societies, that describes the situation as an “imminent storm” creating an “extraordinary financial and administrative burden as well as mass confusion for physicians.”

It’s time to speak up. Submit your comments on the proposed Stage 2 meaningful use rule.

6 thoughts on “Meaningful Use Stage 2: What’s Wrong With This Picture?

  1. Couldn’t agree with you more, Evan. We’re having nightmares just getting some of the RECs to play by the rules for Stage 1…forget about Stage 2. Some states are demanding paperwork that isn’t anywhere in the requirement list, each state (and then people within that state) has a different definition of how to count Medicaid patients, and now we have states even going on record pushing our clients to produce ARRA reports with a different definition than what’s in print (and certified).

  2. Computers are wonderful; no one can deny their benefit. I am unaware of any study that shows that EMR improves patient care. Patients don’t like talking to a doctor’s back or at best glancing eye contact while the physician is poking at his computer screen. A push of a mouse button and a full physical exam is produced. I have been flabbergasted at patients then telling me the doctor never touched them. Upcoding ROS, PMH, FH etc. at every F/U visit is just a swipe of a mouse. Try and find something clinically helpful in the record is a chore. Who is going to pay for the computer’s capital cost, monthly service fee, and new upgrades? The new meaningful use data cannot and will not be read by the users. How about HIPAA compliance. I am not aware of any computer data that cannot be hacked into. By the way, a practice comes to a standstill when the computer goes down! Computers are wonderful, just not EMR. We are all seeing the emperor’s new clothes! LK

  3. Dr Kanter is 100% right about EMR. What he fails to realize, however, is that the main purpose of EMR (particularly for Medicare patients) is to regulate the delivery of care to seniors. EMR will allow the government to eventually deny hip replacement surgery for an alert 88 year old, based on statistics that show the probable life span of said 88 year old. Eventually Medicare will require authorization for all surgical procedures. Seniors who are hospitalized will be denied procedures and extended care beyond the ‘norm’….the secret being that extended care costs the government too much money. We have a government that would prefer to spend trillions on a war in Afghanistan, for ‘democracy’ in Afghanistan, rather than spend that money on healthcare for seniors who have paid into the system their entire life. President Obama stated in a press conference a few weeks ago, that “I want to ensure peace in the Arab world.” Fortunately it’s American citizens who will be voting, not Arab citizens, in the upcoming presidential election.

  4. It is worth emphasizing a point Evan makes about physicians inability to read the rules that govern their profession. Physicians are not alone. We are all being governed by laws and regulations and rules that we cannot possibly read, much less understand. As a health care lawyer I can read the rule however I cannot “understand” it. The normal tools that one not trained as a lawyer employs to derive an understanding of what one reads (logic, reason, common sense) are of no practical use. To attempt to reconcile the words with these concepts is an invitation to frustration. One trained as a lawyer uses these tools as well as concepts such as legal precedent, harmonizing with legislative policy and the scope of regulatory authority to interpret the plain meaning of the words in the context of the public policy they are supposed to promote. Little wonder that the best we as lawyers can do in advising our clients is try to steer them down the grey road that lies between the black and white curbs.

  5. The emperor’s new clothes continued. A computer office system will cost $30 to $40k per physician capital plus $1k per month service fee and then the cost of upgrades. Who is going to pay for this? In a major hospital in Jacksonville, FL a new computer system has been installed that makes physicians data entry clerks. Physicians spend 95% of their time on the computer. There is not much time for patient contact. Most notes are cut and paste the previous day’s note with a BP update to document that the physician was there that day! I asked the hospital why a voice activated system was not used. “It is too expensive” replied administration. It is cheaper for hospitals to make physicians data entry clerks; they don’t have to pay us.

  6. The whole thing is a mess because in the beginning the government (congress) refused to make the software open source. A bill sponsored by Sen Rockefeller of WV languished in committees because software companies lobbied against it.

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