THCB

Meaningful Use Requires Meaningless Data

Race is a medically meaningless concept.

Spare me the few tired cliches about prostate cancer, diabetes, and sarcoidosis being more common in blacks than whites, or even the slightly increased risk of ACEI cough in patients of Asian descent. We screen Jews of Ashkenazi descent for Tay Sachs without any racial labeling. All that information is readily accessible under the Family History section of the medical history. It is no more than custom which dictates the standard introductory format including age, race, and gender. It turns out I’ve blogged about this before at some length (pretty good post, actually). What is new is the advent of electronic medical records.

Much hullabaloo has been made about federal stimulus funds allocated to doctors as payments for adopting EMRs; “up to $44,000!” Here’s the problem with that figure, though, including how it breaks down (source here):

[M]aintaining [an EMR] costs multiple thousands of dollars a year. Bear in mind that they’re not talking about a lump sum payment of $44,000. It’s $18,000 the first year, $12,000 the second year, $8000 the next, $4000 the next, and then $2000, for a total of $44,000 spread over five years. FOR A SYSTEM EXPECTED TO COST AN AVERAGE OF $10,000 PER DOCTOR PER YEAR, not counting the start up costs, which run in the vicinity of $50,000. $44,000 over five years for something that will cost us $90,000 over the same period? And that’s even if they actually get around to giving out the money in the first place! According to this, in order to qualify for “meaningful use,” EMRs must be used for ePrescribing, for communicating with other EMRs like labs and hospitals, and for transmitting information on performance measures (the paternalistic proxy for “quality”) to the government.


Just because my electronic systems didn’t end up costing me anything, it turns out that even though I bill Medicare less than $25,000, I’m still eligible to apply for some of the stimulus money. So just for shits and giggles, I hooked up with a government funded entity whose stated purpose in life is to help me get that money. Cool.

I’ve had a couple of visits with them so far. It turns out that my freebie EMR has features which I hadn’t bothered using yet, mainly because they didn’t seem particularly useful in the provision of medical care — that’s what I do, remember? — to patients. One of them was a so-called “Demographics” section, right below such vital information as patient name, address, phone numbers, and birth date. This section contains three pieces of information I have to enter, one from a set of radio buttons, and two from pick lists, mechanisms that allow for the collection of what is known as “structured data” instead of just information I type into the EMR “free form”.

The first item is “Ethnicity”. There are three radio button options: Hispanic, Non-hispanic, and Unspecified (the default).

The second item is “Preferred Language”, to be selected from a pick list. I can only enter one option.

The third item is “Race”, again to be selected from a pick list. They include “African or African American”, “Asian or Asian American”, “European or Caucasion American”, plus several other basically meaningless classifications. (For example, what entry do I use for an individual from the Indian subcontinent?) Unlike “Language”, I can enter as many of these options as I wish.

What? The? F?

Aside from the language entry, which could perhaps be useful in a very large, very diverse practice, neither “Ethnicity” (limited to Hispanic or Not) nor “Race” has any possible legitimate bearing on diagnosis, treatment, or any other aspect of medical care. And yet an integral part of Government-defined “meaningful use” consists of completing this section of the medical record.

Interestingly, a stated later requirement is for me to submit information from my EMR to the government, ostensibly for what they’re currently calling “reporting purposes”.

Now, what government function uses demographic data like race and ethnicity (ie, Hispanic or not)? Would that be the tracking of, say, voting patterns? And doesn’t it seem like a handy way to collect that data, neatly sorted by address and birth date, rather than having to use the decidedly old-fashioned, up-to-a-decade-out-of-date but actually legal way of tracking that information through the census?

How Orwellian to require that “Meaningful Use” incorporate the recording of medically meaningless data.

Dinosaur MD (aka, Lucy E. Hornstein, MD) is a solo-practitioner in Family Medicine. She is also a book author (Declarations of a Dinosaur) and posts frequently at her blog, Musings of a Dinosaur, where this post first appeared.

Livongo’s Post Ad Banner 728*90

Categories: THCB

Tagged as: , , ,

21
Leave a Reply

10 Comment threads
11 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
14 Comment authors
Charles STimmy DChandresh ShahRob NKatherine Recent comment authors
newest oldest most voted
Chandresh Shah
Guest

I am appalled at the post. The entire purpose of EMR, structured data and continuity of care is about improving the health of the nation; not just an individual. A clerk in a large hospital can’t say in order to do my job well, I don’t need to waste time entering data into a computer. I don’t need to track expenses because I can track them in my head. Add up these hundreds of employees and imagine them doing their own thing!

Rob N
Guest

I completely agree with this article, “Meaningful Use” and some of the data points collected are not the best use of a clinicians time. Some of the crap our health care system comes up with is beyond me.

Michael Millenson
Guest
Michael Millenson

This post is wrong, on the science, about race not being a scientific concept — with an asterisk. “Race,” in this case, is a proxy for a particular group being in a particular geography with intramarriage for such a long period of time that it is genetically distinct. So, for instance, while Ashkenazi Jews are not a “race,” they are genetically distinct in terms of BRCA susceptibility. Similarly, while “Asians” are not a race, there are, in fact, different racial subgroups of Han Chinese and, say, the Koreans, who trace to the Alatic group common to Mongolia. Because of the… Read more »

Matthew Holt
Guest

Mike–I can call anyone I like anything I like, and so can you. Welcome to America and the first amendment. I’m unaware about any comment deletions and I don’t do those anyway myself other than obvious spam. but if you care to tell me what got deleted I’ll look into it.

BobbyG
Guest

Copy that.

BTW, I’ve just cited this post on my REC blog.

pcp
Guest

Reposing to your comment on your blog:

How can the original poster “strategically mine” the data from her practice on race, ethnicity, preferred language, exposure to passive smoke, etc., to improve the health care she offers her patients?

BobbyG
Guest

Implicit in your question is the insinuation that the data in a doctor’s EHR is on no empirical value beyond those pertaining to an individual patient.

Also implicit (and I would tend to agree) is perhaps that practicing docs are not researchers, and would have neither the time nor inclination to drill down into their data when it’s all they can do to keep the doors open.

We have people working on that problem. We see it as an opportunity.

I repeat: “Don’t Ask, Don’t Know.”

BobbyG
Guest

Oh, for “edit” functionality, grrrr… I HATE to make typos. 🙂

Dr. Mike
Guest
Dr. Mike

And a bit ironic, don’t you think Matthew, that you deleted one of my posts that called one of your favorite contributor’s articles “rubbish” and yet here you are doing the same thing, and on your own website! I know you can do what you want, it is your site, but to so brazenly let us see who you really are…. And I can’t help but chuckle a little as I think about how you might respond (not that you will, but I can pretty much guess your thoughts). You will either delete this post, or you will immediately try… Read more »

Matthew Holt
Editor

When you’re getting free money from the taxpayer (not including what they spent on that entity that is sending consultants to help you) why do you have the right to complain that the taxpayer wants some return from you? Even if what they want in return is only stuff that can be cross correlated with Census data. BTW that census data collection was designed by someone who thought about this a whole lot more than you did, Dinosaur……. And I would warrant a guess that your data, once it’s collected and compared to other, may show that you’re not practicing… Read more »

pcp
Guest

Rude and inappropriate post, especially from someone in your position.

Dr. Mike
Guest
Dr. Mike

Unbelievable. Is this post really from the owner of this site? Wow. I didn’t ask the taxpayers for a dime. I’m happy to use my EHR without any incentive at all. But you are completely ______ if you think that the incentive will not be followed by a disincentive, as in a penalty for not using my EHR “meaningfully” sometime in the not so distant future. I for one plan on going for the first relatively easy $18K, unlikely to pursue it further. You can think what you want of me, but I would wager a large sum that is… Read more »

Timmy D
Guest
Timmy D

@Matthew Hold: Free money? Really? Come on now, taxpayer money is not free, it is confiscated from citizens and then in this case squandered on something unnecessary. The government lures providers in with the promise of “free money” but I would wager then end up spending more money implementing “Meaningless Use” than what they gain back. I say this as an EMR Analyst who has implemented Meaningful Use at several large hospital systems and has seen all the work that goes into it.

Timmy D
Guest
Timmy D

@Matthew Holt: Big government is going to save us, right? Good thing meaningless use was designed “by someone who thought about it a lot more than we did…” Probably the same type of person in the news for wasting $1m on a party from the GSA recently! You are a fool if you trust the government to design a health care system that anyone can count on. Just like all Big Government people, you want to hand out money that isn’t yours as incentives and then claim you have a stake in how people operate their business.

Jonathan H
Guest
Jonathan H

$10,000 per year per physician….where did you get this cost for an EMR? Did it take into account any savings from EMR use, or only costs? Why is this number flat, instead of being higher in the first year and then diminishing as the workflow is adjusted and physicians get more comfortable using it?

The cost-benefit calculation is not the same for all practice sizes, and of course it will depend on what EMR is purchased and used.

Margalit Gur-Arie
Guest

Jonathan, The flat subscription price for an EHR/PMS, inclusive of interfaces and patient portals as needed for Meaningful Use, ranges from around $700 to well over $1000 per physician (or NP) per month. This does not include hardware, network, labor, training, productivity loss, or staff licenses (if required). There are no savings in physician productivity – you cannot see more patients with an EHR. There may be savings in staff labor, but they are usually offset by IT labor. There are some savings in paper products and cartridges and maybe a fax line. I have not found significant differences in… Read more »

Charles S
Guest
Charles S

I was told by a EMR expert that use of an EMR will cost a practice $60,000 a year in lost productivity. And that the break even point might be age 48 years, beyond which a physician should not implement under current condiotions. Meaningless, meaningful use will allow you to turn a 8 line SOAP note into a 2 1/2 page termplated bullshit note. Of course everyone knows it only happened, if it’s recorded in the record. Of course it allows untrained clerks to assess quality of care, becuse you did 5 from column A, 4 from column B and… Read more »

Margalit Gur-Arie
Guest

The “new” EHRs are not designed for patient care. They are designed for research and measurement, with the assumption that these activities will improve patient care indirectly.
More here https://thehealthcareblog.com/blog/2011/05/24/npfit-blazing-the-trail/
(it’s not really about the UK)

Katherine
Guest
Katherine

I think that’s an interesting point. Although EHRs are touted as a way to reduce medical errors and streamline processes, the implications for this technology are far-reaching. There’s some interesting info about the impact of EHRs and other HIT here: http://ignite.optuminsight.com/archive/the-power-of-it/ The article notes that with the ability to look at data in aggregate, metrics will become a powerful tool for improving quality of care. I’m curious to see how EHR data will be used in the coming years. The “Race” entry aside, the data could be industry-changing.

BobbyG
Guest

I will be blogging about this post. Count on it.

tim
Guest
tim

Lots of physicians are collecting lots of data which they do not need for that $44,000. It costs money and time to collect this useless stuff. In other words, the American taxpayer will pay doctors to be less efficient, in the name of paying them to be more efficient. Central planning always looks like a scene from the keystone cops. Always. In the private sector, there is a feedback loop to discipline inefficiencies (when there is a functioning market.) By definition, government decisions are insulated from such feedback. (No, I know what you are thinking — elections do not function… Read more »