Saturday, March 28, 2015

Follow-up: Meaningful Use Stage 3 is coming

Yesterday, I posted "Meaningful Use Stage 3 Is Coming: Should Be Fun" which discussed some onerous new rules that Stage 3 will impose including this one:

More than 25% of patients seen by an eligible professional (EP) or discharged from a hospital or emergency department (ED) must "actively engage" with their electronic health records (EHRs).

I said that in my experience most of the patients I took care of would have been unlikely to engage their EHRs and expressed concern that physicians would be penalized for their patients not reaching the 25% threshold.

A reader commented that the VA has had a patient portal called the Blue Button since 2010. He pointed out that in May of 2012, more than 500,000 unique patients had accessed their EMR. He meant this as a rebuttal to my opinion about the potential level of engagement.

However, it turns out that in 2012 over 6.3 million patients were treated by the VA system.  [See page 4 of this link.] If you divide 1 million by 6.3 million, you get 15.9%.

It seems like they have quite a way to go to get to 25%

I rest my case.


artiger said...

I think this idea of all patients engaging their EHR's is about a generation (perhaps a little less) away. No offense intended.

Skeptical Scalpel said...

Maybe. But a lot depends on what type of practice one has. I can see a general internist having a lot of patients who might want to see their lab work or something. But take a general surgeon for example. Despite everything you hear about the huge number of errors and deaths we are causing, the fact is the most patients we operate on do quite well. There is no reason for them to want or need to look at their EHR.

Anonymous said...

Surgeons wouldn't have operative reports on EHR. The EHR is good for lab work and specific questions about medications/interactions and 'here is a problem do I need to see you' type of thing. That sort of engagement yes, but for surgeons, I can't see it.

frankbill said...

In the VA surgeons write a report that is part of the EHR. One of the things that other providers need to know is if surgical staples were used and what type they were. This can affect MRI scans.

Skeptical Scalpel said...

The type of staples we use inside the body are made of non-ferrous metal. They are not magnetic.

frankbill said...

It's been a few years since I had an MRI. If I remember right I was asked if I any surgical staples. At that time the answer was no.

Since I now have had appendix taken out the answer would now be yes.

From my searches some say staples are not a problem others say they have been turn downed because of the staples. Also seems to it depends on both how old the MRI machine is and the type of scan being done.

Either way the information should be part of the EHR

Skeptical Scalpel said...

I normally would not prolong a debate here in the comments section of a post, but I feel I must because readers may be misled by what you have said about staples.

From the website (

"Various hemostatic vascular clips, other types of clips, fasteners, and staples evaluated for magnetic field interactions were not attracted by static magnetic fields of MR systems operating at 3-Tesla or less. These implants were made from nonferromagnetic materials such as tantalum, commercially pure titanium, and nonferromagnetic forms of stainless steel. Additionally, some forms of ligating, hemostatic, or other types of clips are made from biodegradable materials. Therefore, patients that have the implants made from nonmagnetic or “weakly” magnetic materials listed in The List are not at risk for injury during MR procedures."


"At 3-Tesla, a variety of hemostatic clips, other clips, fasteners, and staples have been evaluated for MRI issues including magnetic field interactions and MRI-related heating. In general, these devices do not present an additional risk to patients undergoing MR procedures."

frankbill said...

Maybe need to do Blog on both CT and MRI scans.

Anonymous said...

Have done many, many MRI's on patients with intraabdominal/intrathoracic clips/staple lines without any problems. I don't even TELL my patients about the titanium staples!

Skeptical Scalpel said...

Anon, thank you for backing me up on this.

frankbill said...

What about other types of hardware that is used is it all MRI safe?

What about Anon posting about Surgeons not putting reports in EHR.

Skeptical Scalpel said...

Each type of hardware has to be evaluated for MRI safety individually. That is why the form you fill out before having an MRI is so extensive.

I had meant to reply to that anonymous comment about surgeons not having to put op reports in the EHR. That is not true. Every operation requires a brief note at the time the case is completed and then a dictated operative report that appears later. I assume if patients are to be given access to their entire EHR, those operative notes and reports would be visible to the patients.

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