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It’s Not About Meaningful Use …

MucartoonWith the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version.  Now it is not to say these concerns are not justified, it just may be that they are misplaced for the vast majority of those who currently do not use an EHR, small physician practices and clinics.  It is within these small practices, which are really just small businesses, that the majority of patient care occurs and where possibly the biggest benefit may be derived in the use of EHRs. It is also here where we may find the highest adoption hurdles, and those adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR.

This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont.  There facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic.  Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on.  For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.

It is stories like this that concern me.

This is a clinic trying to do the right thing, trying to use an EHR in a meaningful way (note, did not say meaningful use) and they are struggling. Yes, they do want to deliver the best patient care, but at the end of the day, they, like any business have bills to pay.  They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice.  Maybe instead of guaranteeing that their application(s) will meet MU criteria, EHR vendors should guarantee that the productivity hit of using their solution will not exceed HITECH incentive payments.  Now that would be an interesting value proposition.

Thanks to Michael Jahn of Jahn & Associates for the MU cartoon.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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Goa India Luxury Resorts ExpertwhitXOliverExhaustedMDReal EHR Man on the Street Recent comment authors
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Goa India Luxury Resorts Expert
Guest

This is a set of phrases, not an essay. that you are incompetent

whitX
Guest
whitX

The subpoena named Blagojevich Obama is something to be expected as the President is asked to testify for the trial of former governor Blagojevich. It was due to the news that Blagojevich was attempting to sell the President’s empty senate seat, without the President’s awareness but rumored to have communications with Blagojevich about the seat. Obama’s still the President of the United States of The US; even if he is subpoenaed to witness on the trial, the challenge that he’d be able to do it is almost none.

Oliver
Guest
Oliver

Start over. Re-examine what works, and proceed from there. You can’t have a rational discussion when someone hangs an ideological statement on every word. You also have to separate the good faith commentary on how to improve existing systems versus debates about whether they should be imposed on private businesses, etc. One can assume the latter comments are not building toward the same enterprise. A main issue with practices trying to implement these systems is communication/expectation. And again, every one of the discussants leaves out patients and patient access/ease of use as a factor in chasing profits. That’s like redesigning… Read more »

ExhaustedMD
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ExhaustedMD

For those who are not computer addicts, have you met some of these people who proclaim how the silicon universe will save us time, money, and energy, and make us better people? I for one walk away from these interactions and wonder what planet they came from to truly believe this crap! It’s just another money scam in the end, and the defenders and apologists do not want you to know this. Just watch the attack that will proceed after this comment. Electronic records have some positive place, I will admit that. But, just use this as an analogy: Gone… Read more »

Real EHR Man on the Street
Guest
Real EHR Man on the Street

Does anybody know if the free ONC government cheese program is distributing free purple shrouds with every EHR? Are these shrouds “certified”?
I would suggest they keep the shrouds, but in the tradition of Dr. Kellogg, substitute yogurt for the cheese.
Wearing the purple shroud in public makes a statement: I’m impacted with EHRs–hence the yogurt cultures.

Real EHR Man on the Street
Guest
Real EHR Man on the Street

Translating Dr. Halamka’s words above, to the buzz on main street, what he said was, “DRINK THE KOOL-AID.”
Then go shopping for your purple shroud.
Beam me up, Scottie…

Steve Ludley
Guest
Steve Ludley

Halamka states: “My advice – trust the ONC folks and Federal Advisory Committees. Join the process. Be open about your opinions. Feel free to disagree with any idea or policy. ”
Of course,he expects us to believe him, especially when HIT vendor shills and HIMSS insiders are holding influential positions, providing educational resources to the lawmakers. Give me a break.

Steve Ludley
Guest
Steve Ludley

“monitor these tools for their impact on safety”
Dear Dr. Kibbe,
Actually, it is whether these tools are safe from the getgo. Since when is it legal to sell medical devices without FDA approval?

Margalit Gur-Arie
Guest

Not sure what triggered this post from Dr. Halamka today, but it addresses some of the subjects discussed here.
For the sake of completeness, here it is:
http://geekdoctor.blogspot.com/2010/03/in-onc-i-trust.html

David C. Kibbe, MD MBA
Guest
David C. Kibbe, MD MBA

For all, a clarification on my own position vis a vis EHR technology and safety: it’s very, very important to monitor these tools for their impact on safety. This has been almost completely overlooked for a generation, but I think that is about to end. If we (that is, our government) regulate EHR technology with respect to its compliance with specific standards for messaging and exchange, then we must also consider that it is appropriate to regulate the technology with respect to its effects on safety and errors. This is coming, as the passion and eloquence of some commenters here… Read more »

The EHR Guy
Guest

If the people in this forum knew what it is like to participate in all these committees to support and promote the health care IT interoperability standards they wouldn’t speak so negatively about it.
I spend my nights and weekends with the spirit of contribution to a cause. Time that I should be devoting to my family and myself.
How disappointing it is to have to read such slanderous statements of some great contributors.
The EHR Guy

Margalit Gur-Arie
Guest

Well, yes, BlueDog, I’m sure he knows all that and maybe more. But does that necessarily mean that he is acting inappropriately?

BlueDogSpirit
Guest
BlueDogSpirit

Good point, e-dollar Bill! If you look at the caption under Blackford Middleton’s photo in the WaPo article, it says “courtesy of HIMSS”. And why is that? Because Middleton was HIMSS Chair in 2006! In the WaPo article, HIMSS worked closely with technology vendors. That is HIMSS EHRVA! “With financial backing from the industry, they started advocacy groups, generated research to show the potential for massive savings and met routinely with lawmakers and other government officials.” HIMSS Advocacy/Lobbyist office is located in the Beltway. The research HIMSS generated came from HIMSS Analytics! HIMSS EHRVA has the big HIT companies as… Read more »

e-dollar Bill
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e-dollar Bill

The national HIT policy has been purchased by HIMSS on behalf of its member organizations. Revisit Robert O’Harrow’s piece in WaPo to dispel any doubt.
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html
Some “honest” people are undoubtedly being used, but who are they? With white collars, Enron and Adelphia executives seemed honest, did they not?

Margalit Gur-Arie
Guest

BlueDog, I am glad you are going to post this to the Register. I have to admit that I don’t follow each person to the extent you do, and what you wrote here is of great concern to me. I did notice for a while that in all these committees and workgroups and semi official bodies, the same names keep popping up, as if there is one little pond of “experts” that get recycled into every new government effort. I guess I should have checked their pedigrees more carefully. I don’t know, but for some reason Dr. Blumenthal strikes me… Read more »