Meaningful Use - Meaningful to Whom? Meaningful At All?

October 4, 2010

The new meaningful use criteria for EHR incentives focus on whether a computer system can perform specific functions or provide particular features - things that are easy to tabulate. It’s harder to determine if you actually use the system and if you, your practice or your patients are better off. There is no assessment of the possibility that computerizing made things worse.

Every practice maintains a medical record on each patient. In most states it's the law. That does not mean that every practice makes meaningful use of its medical records when caring for patients or for running the practice. 

Above all, meaningful use depends on a commitment to quality patient care, efficient business operations, and attention to detail. These things take time and cost money; there is a wide spectrum of approaches that range from minimally acceptable to superior.

It’s the accuracy and completeness of the information in the record that is critical. Practices that pay scrupulous attention to detail have used paper records for years and delivered superior care. A computer system, at best, is primarily a tool for recording and retrieving information and does not magically improve the information gathering process. Only if information is gathered quantitatively and accurately can it be used by the computer for decision support.

The new meaningful use criteria for EHR incentives focus on whether a computer system can perform specific functions or provide particular features - things that are easy to tabulate. It’s harder to determine if you actually use the system and if you, your practice or your patients are better off. There is no assessment of the possibility that computerizing made things worse.

The initial meaningful use criteria require a system that can:

• Record demographics
• Maintain a problem list
• Maintain an active medication list
• Give patients, upon request, an electronic copy of their chart
• Use CPOE
• Implement drug interaction checks
• Have capability to exchange key clinical information
• Implement at least one of four clinical decision rules
• Report hospital quality measures

I have my own criteria of meaningful use:

• The medical record is legible, complete, and individualized.
• Each entry describes in detail what was going on with the patient, what the practitioner thought about it, what was planned and why.
• Follow-up visits include a description of what happened as a result of the plan. Did the patient, the lab, etc., all do what was expected? Did the patient respond to the treatment as expected?
• The chart can be read by simply "turning the pages." Entries all appear to be in one place, sorted either chronologically and/or by other categories. Being required to jump from screen to screen or to access many separate systems does not qualify.
• Entries from all specialties and practitioners (regardless of level) are included and, if a computer is used for documentation, all practitioners can receive equal assistance in completing their tasks.
• The patient's problems, allergies, current medications, and relevant alerts and reminders can be reviewed and acted upon easily.
• Copies of relevant entries are provided to other practitioners when making or responding to a referral. Relying on the patient to explain the reason for your referral to the specialist does not qualify.
• The patient is offered copies of progress notes as a way to reinforce your recommendations and reduce the chance of misunderstanding.
• The system demonstrably improves profitability.
• The practitioners get home in time for dinner.

Which set do you think is more likely to result in higher quality care and lower overall healthcare costs?

Daniel Essin, MA, MD, FAAP, FCCP, will be a regular contributor to the Practice Notes Blog. He has been a programmer since 1967 and earned his MD in 1974. He has worked at the Los Angeles County and USC Medical Center where he developed a number of internal systems, chaired the Medical Records Committee, and served as the director of medical informatics. His main research interests are electronic medical records, systems architecture, software engineering, database theory and inferential methods of achieving security and confidentiality in healthcare systems.