Meaningful Use: The Electronic Communication Requirement

One of the core requirements of meaningful use under CMS' EHR Incentive Program states that to qualify, the provider must have: "Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically."

This is a very good thing, because electronic communication between healthcare providers has the potential to radically change healthcare. Referring physicians, consultants, and patients all stand to gain from its use, giving better, more informed care, reducing frustration and saving money.

Here's what I mean:

• I see a patient and need some help from a specialist.

• I e-mail a quick note to the specialist, attaching recent labs, notes, and the reason I need his help.

• The patient goes to the specialist, who is happy because he is not left to guess about the purpose of this visit.

• Since I have given background clinical information, the chance of duplicate tests is less, which saves money.

• Instead of a generic consult note scanned into my EHR, I get a direct answer from the specialist via e-mail. I also see medication changes and test results done by the specialist.

So what's the catch? There must be one, as I have never had such an encounter in the 16 years I have used an EHR. Despite the fact that most of my consultants have computerized records, most won't accept electronic communication, and they send their notes on paper, requiring me to scan the copy into my EHR. If Physicians Practice used this method, they would print out my column and mail it to you so you can scan it into your computer to read it. It's terribly inefficient.

So why would a ubiquitous technology that improves care, reduces frustration, and saves money be so universally avoided by providers?

Here are some of the reasons:

• Doctors are afraid of committing privacy violations; not understanding what is truly safe, and what will get them in legal trouble.

• Health systems are reluctant to share data outside of their own system.

• EHR systems are still proprietary, making sharing difficult on both ends.

So what about meeting the core requirement? Fortunately, the EHR only has to show the "capability" to communicate, meaning that a single demonstration of this being done on a test patient is enough to qualify. Please note that communication cannot be within an organization or within a single EHR system.

In truth, meeting the requirement is simple for most systems, as most EHR vendors will have instructions for communication of this core information. But if the goal is not simply to qualify for the money, but to truly use the system in a meaningful way, the battle is much harder. Here are some steps that I have taken to move things in a positive direction:

• Get the e-mail addresses of any physicians I refer to. I've gotten a lukewarm reception on this, but it's getting better.

• Since our system has a secure patient portal, I can provide valuable clinical information by sending a link to access the portal for specialists.

• I have enabled the option to respond to my communication electronically, and have had a growing number of physicians take advantage of this.

• I am more likely to refer to a physician who receives electronic communication, and will eventually require them to accept it from me in order to get my referrals.

My hope is that acceptance of this technology will grow, just as acceptance of ATMs was accepted by the public: nobody had to promise you $18,000 to use an ATM; it was just easier than not using an ATM. The same thing is true with electronic communication, as long as the hurdles of privacy and EHRs not playing nice together are solved.

* Another meaningful-use requirement is the clinical summary. To find out how to produce a clinical summary that is both helpful and "meaningful" read: "Clinical Summaries: A Valuable Part of Meaningful Use Requirements."

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting. He authors the popular medical blog “More Musings (of a Distractible Kind)” http://more-distractible.org. Dr. Lamberts can be reached at rob.lamberts@gmail.com.