Friday, March 27, 2015

Meaningful Use Stage 3 Is Coming: Should Be Fun

An alert reader tipped me off to something many of you may not be aware of. Stage 3 of Meaningful Use is close at hand.

The "proposed" rules will be officially published on March 30. The good news is that comments will be received for a couple of months.

The bad news is that if the Office of the National Coordinator for Health Information Technology is anything like every other regulatory body I've ever dealt with [e,g., the ACGME's Residency Review Committee for Surgery], the "proposed" rules will be the real rules and the comments will be simply a way for disgruntled physicians to vent.

If you don't believe me about the venting, take a look at the 185 mostly negative comments posted on Medscape’s story about Stage 3.

Here are a few of the new rules that will be in effect by 2017 or sooner.

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).

When I was practicing, I had trouble getting some patients to take their medicine or even get out of bed. I don’t know where the people making these rules live, but most of my former patients were highly unlikely to actively engage with their electronic records. I suppose as is the case with unplanned readmissions of noncompliant patients, penalties will be handed out if only 24% of one’s patients engage their records.

Patient-generated data from a nonclinical setting must be incorporated into the EHR for more than 15% of patients seen by the EP or discharged from a hospital or ED.

A “nonclinical setting” is something such as home health care or physical therapy. How anyone is going to be able to track this? Did they mandate only 15% because they know this will be nearly impossible to comply with?

EPs and hospitals must use their EHR to create a summary of care and electronically exchange it with other providers for more than 50% of transitions of care and referrals. In more than 40% of these transitions of care, the provider has to incorporate in its EHR a summary of care from an EHR used by a different provider. In more than 80% of transitions of care, the provider has to perform a "clinical information reconciliation" that includes not only medications and allergies, but also problem lists.

EHRs from different vendors lack "interoperability." They don't communicate very well with each other. “Copy and paste” is out of control now. Wait until you see what happens when people try to comply with these transition of care rules—assuming that EHRs from other doctors can even be opened. This is going to be a monumental amount of work, all of which of course will be uncompensated.

I retired more than two years ago. In social situations, I’m often asked, “Do you miss being a doctor?” I miss the satisfaction that came from helping patients and most of the people I worked with, but I don’t miss the ever-expanding bureaucracy, regulations, and busywork associated with practicing and teaching surgery.

Old age has its rewards. One of them is not having to deal with Stage 3 or even Stages 1 and 2 of Meaningful Use.


frankbill said...

Find it interesting that 25% of patients will need to see there record. Has to be a reason for this. Seems to be related patients need to record visits.

Skeptical Scalpel said...

On the contrary, it is possible that no patients will "need" to see their records, but if less than 25% "engage" their records, the doctor or hospital will be punished.

artiger said...

I don't guess the meaningful use geniuses realize that in many regions of the country a lot of patients either have no internet access or are computer illiterate.

I'm generally in favor of electronic records, but this meaningful use stuff is not helping anyone, except the policymakers themselves.

William Reichert said...

Artiger, you must understand that if patients don't have a computer, all you have to do is establish an email account for the patient. At check out
the secretary pulls up a screen having something to do with patient's
visit and send it to the email address.The patient checks a box that registers the patient's having engaged their record.( seen the email).
The meaningful use rules will result in employing tech folks to satisfy the requirements with a click of the mouse. It is creative fun!

frankbill said...

William Reichert

Since IP addresses can be tracked doing what you say could be looked at as being illegal.

Since I can only look at this as a patient I can see the need for part of this. There are a lot of not so good provides out there.

The down side to this going to make the poor and anyone over 65 find it harder to get medical care.

Skeptical Scalpel said...

Yes, many just can't imagine that there are some folks out there who just don't care about computers or the Internet.

Frank, you are correct that IP addresses can be checked, but who is going to go to all that trouble? This is a game. What the bureaucrats are looking for is checked boxes. They give us the boxes and we check them.

artiger said...

William Reichert, I certainly understand how stupid rules can be bypassed or "managed". A problem I see with doing so is when we figure out efficient methods to satisfy inefficient regulations, more rules and regulations will follow, to which we will find more ways to game the system, and on and on. Meanwhile, none of it is helping patients.

frankbill said...

All it takes is one unhappy patient and someone will check IP addresses.

VeinGal said...

Its terrifying to me, as someone who has yet to enter 'real' practice, that so much of "healthcare" these days has the very least to do with care or health.

frankbill said...

From the following looks like some without internet would be exempt.

We are proposing a continuation of the exclusion in Stage 2 for both EPs and
eligible hospitals/CAHs in that any EP, eligible hospital, or CAH would be excluded
from the first measure if it is located in a county that does not have 50 percent or more of
their housing units with 4Mbps broadband availability according to the latest information
available from the FCC at the start of the EHR reporting period. We continue to
recognize that in areas of the country where a significant section of the patient population
does not have access to broadband internet, this measure may be significantly harder or
impossible to achieve.

Anonymous said...

"I don’t know where the people making these rules live,"

I think all of us know - medical personnel AND a number of the savvy patients who think the same mindset that gives us our government is the same one doling out rules for you guys.

Skeptical Scalpel said...

Frank, thanks for the link. I think I'll skip the 300 page though. Here's a question. Say 60% of people in an area have broadband Internet. Do the docs need to have 25% of the 60% engaging their EHRs or is it 25% of the whole population?

Anon, it was a rhetorical question. I think I know where the eggheads live.

Skeptical Scalpel said...

Veingal, I think you are wise to be terrified.

frankbill said...

It would take a while to get through the 300 pages. Then trying to understand it might takes weeks.

frankbill said...

As I am part of the VA health care system I can see the benefit of being able to see my health record on line.

What I can do.
Features available to Veterans with a Premium Account include VA Notes. These are clinical notes that your health care team records during your appointments or hospital stays. Also available are your VA Immunization records, more detailed lab reports and a list of your current medical issues. These features are in addition to prescription refills, VA Appointments and Secure Messaging – all very popular with Veterans!

From Wikipedia

VA launched the Blue Button function on its patient portal, My HealtheVet,in August, 2010.[28] By May 2012, more than 500,000 individual (unique) Veterans had used the Blue Button to download their data. They opt-in to be able to download their health data, first by registering for a My HealtheVet account, and second, by validating their identity for privacy and security reasons, which includes appointment information, prescriptions and medications, laboratory results, vital signs and readings, military health history, and military occupations. In August 2012, the Department of Veterans Affairs announced that the Blue Button has one million registered patients.

Skeptical Scalpel said...

Frank, thank you for your latest comment which proves my point. As of 2012, the portal had 1 million registered patients. In 2012, there were over 6.3 million patients treated by the VA [page 4] 1/6.3 = 15.9%. So only 15.9% of those eligible to engage their EHR did so. I rest my case.

Jane said...

Home Health computer work already takes about 4 hours of time already to admit a patient. Actual hands on care for that 4r hours is approximately 15-20 minutes. Adding to what already has to be done to reconcile with every provider; Heck, you may have to just stay all night with the family do get one patient done that day! We are drowning in data and it hasn't helped provide coverage or improved healthcare to the masses.

Skeptical Scalpel said...

Jane, I recently read a visiting nurse service intake form that was 40 pages long and 95% of the fields were left blank.

Anonymous said...

Some of the enemy..with more joining each year (Insurers, even of the Medicare Advantage Plan variety) have contracted with outside companies providing RN case managers at no additional cost to members of their plans with runaway chronic and complex healthcare issues. These CMs are truly dedicated to care coordination and best outcomes for their patients (not the insurer, I RNs these CMs have an ethical code to uphold, tipped in favor of patients). Perhaps one strategy physicians might consider that may help with some of these Meaningful Use headaches is encouraging their complex needs patients to inquire of their insurer a CM to help them with care coordination. Think about it. It's free to both physicians and patients, will provide an RN who will support patients with the plan of care their doctors have recommended, decrease re-admissions through early intervention by way of frequent contact with patients by RNs, and I'm certain there's a way they could legally help with some of these R & R's for previous and next stages of MU. A suggestion--or urging--by a physician would be all it would take for many in-need patients or their primary caregivers to reach out and ask for the assistance. True inter-professional collaboration at work.

Skeptical Scalpel said...

I had not heard of this. Why has it not been publicized more?

frankbill said...

Here is some information from Blue Cross Blue Shield of Michigan

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