Trials and Tribulations of Achieving 'Meaningful Use'

July 11, 2011

We have been in the process of preparing for meaningful use attestation. We have had to make some changes in how we practice. Not how we practice medicine, mind you - just how we play the game.

We have been in the process of preparing for meaningful use attestation. We have had to make some changes in how we practice. Not how we practice medicine, mind you - just how we play the game.

For example, I have always handed my patients educational material when appropriate. I have some in the waiting room, I have some at the front desk, and I have some in the exam rooms. I have some stuck in drawers and in closets, and depending on the patient and the situation, I break out a handful of them. But that doesn’t count towards “meaningful use.” So now everything has to be generated through the EHR. So while I still have these beautifully pre-printed pamphlets (which were free, I might add), I have to print out material from the computer.

I also, partly out of convenience, used to write “90-day supply” for things such as test strips and needles and other “use 3-4 times a day” items, and fax them (via computer) to the pharmacy. But since I have to e-prescribe a certain percentage of prescriptions, and you need to specify a quantity and not just a days’ supply in order to do that, I now have to figure out “if the patient is taking 6 units with breakfast and 10 units with lunch and dinner, and needs to do an air shot each time, that’s 6+2+10+2+10+2, times 90 days, divided by 300 units per pen, and there are 5 pens in a box…”

Today, I just figured out why my system keeps saying that most of my lab orders do not have results as structured data. Orders I write today aren’t going to get done today. I hand my patients lab slips and say, “have this done before you follow-up in three months.” So when my system pulls the orders for this week, none of them have results, let alone as “structured data.” I’m not sure how I’m going to get around this one. I really don’t want to change the way I’m instructing patients to get labs.

Then there are “timely access to health information” and “summary of care provided for patients transitioned to another health care facility.” My patients don’t ask for electronic access, so how can I provide it to them “in a timely manner.” I could if they wanted me to, but they don’t. I have a patient portal, and I think 10 patients use it. And as a specialty outpatient office, there’s no transition anywhere. I take that back. In the last two years, I sent one patient to the emergency room. Big whoop.

This is still a work in progress. Hopefully , we’ll get things straightened out in the next few weeks. I cross my fingers.
 

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