Meaningful Use - Take two aspirin and call me after you read this Doctor!

Meaningful Use....  That is what I've been hearing about lately, especially since working on my HIPPA security project. I guess I've heard about Meaningful Use in the recent past, but not by name, and certainly did not pay it much attention. It seems to be a challenge that the people in the doctor and dentist offices that I work with are now scurrying around trying to satisfy. One day I sat down for a meal at a restaurant with someone who is very close to me, but shall not be named. This person is a nurse who manages an office at a local clinic, which is part of a big hospital chain here in Indiana. I was aware that her entire hospital system recently went through a software change and we were discussing whether life was better or worse after that change. Besides her opinions of the joys of learning and adjusting to new software, she told me that they were under a lot of pressure to meet some requirements for something called Meaningful Use. She said that the doctors had to “attest” that they were able to perform certain functions by a certain date or their Medicare reimbursement would be reduced. She said that they had some consultants going through the different departments of the hospital and making sure that everyone was on track to meet the “Meaningful Use” requirements.

As we were eating, she described how the clients at their office were mostly older people in their 70's or 80's, who mainly pass through, never to return. She explained how it was her job to somehow establish follow-up and ongoing communication with these patients, that they would normally forget about, as a requirement for this meaningful use. The problem is that they did not want to hear back from those patients any more than those patients wanted to hear from them and, given their age, hardly any of them use computers or care about communicating through any type of e-mail or interactive social media. They wound up sending out Christmas cards to a list of former patients meeting certain criteria, with information about how to deal with stress over the holidays. That somehow satisfied the requirement. This left me scratching my head and feeling a little embarrassed that I did not know anything about this thing called “Meaningful Use”. I did determine that this was something that I should look into.

My stated goal for 2015 is for all my customers at medical practices to become HIPPA compliant. I've been studying HIPPA extensively over the past few months, especially the requirements that deal with computers, networks, and data security. I even came up with an active firewall that I plan to install at these practices in order to help meet or exceed HIPPA requirements. The timing for this is good because hacking is a hot topic in the daily headlines and everyone is paranoid that they might be next. Achieving HIPPA compliance is a lofty goal and plenty to keep us busy in 2015, but still this “Meaningful Use” is also a real concern that needs to be investigated.

Now those who know me know that I am a practical person who attacks problems in a practical way. I am also known for getting things done. I like to study subjects until I have a true understanding rather than simply glossing over materials until I learn a few new vocabulary words, or in this case acronyms to toss around. Nothing irritates me more than consultants and sales people tossing around their new vocabulary words.

I got on my handy Kindle Fire to pick out a book on the subject and wound up with “Hacking Healthcare”, A guide to Standards, Workflows, and Meaningful Use. The book is published by O'Riley who has published many of the technical books I read over the years. It is a book written for IT People, and it helps to have several years of IT experience to get through it. The weather forecast was bad, which is ideal for settling down and reading a good book. I have to admit that this book is not exactly entertainment. If you choose to read it, I recommend reading from a soft chair or even propped up in bed because nothing will put you to sleep more quickly than reading about government programs and requirements.

The book did a good job of laying out Meaningful Use in a way that made sense to me. It also goes into some history of the evolution leading up to and the reasons behind Meaningful Use. This book has been around a couple years, so it is dated and does not contain the latest changes to the actual rules for Meaningful Use. To get the latest, you must go to the government websites where it gets really boring but at least the information there is the “official” version.

After reading the book as well as the supporting websites, and thinking about what this means for the small medical practices I work with, here is my practical take on Meaningful Use:

  • The reason I did not pick up on Meaningful Use in my study of HIPPA is that Meaningful Use and HIPPA are two different things. Meaningful Use is not even part of ObamaCare, although it might as well be. It was conceived in the heads of the same bureaucrats to be sure and shares some of the same goals in the long run. Meaningful Use first came about shortly after Obama was elected in 2008. Meaningful Use first officially appeared in the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act of 2009 (ARRA). $20 billion of that money was set aside by Congress to go to doctors and hospitals who “meaningfully use” their clinical software. This was the first step of Obama's comprehensive plan for Healthcare Reform. ObamaCare was later passed in 2010.
  • So the government had $20 billion of taxpayer money for doctors, hospitals, and practices to go out and buy new “Electronic Health Records” software and go paperless. Does the term “Shovel Ready” ring a bell? In order for particular software to qualify for this program, it has to conform to certain standards laid out in Meaningful Use. That's right “Free Money For Software” ….. with a few strings attached. I think the average small practice could receive between $60 to $80 thousand dollars as an incentive to upgrade their Practice Management Software. This covers roughly 85% of the total cost. So who wouldn't think that is a good deal? One of the easiest and most obvious ways to spot software that was designed or upgraded for “Meaningful Use” is to look at the biographic screen where they ask for the sex of the patient. Under “Meaningful Use” there are several possible answers to describe a patients sex besides simply (M)ale or (F)emale.
  • Today, doctors, hospitals, and practices who received government incentive money to implement their new software must now comply with “Meaningful Use” or risk having their incentive payments reduced or cut off. That sounds fair enough, but that is just the beginning. Those who did not take advantage of the incentive money or implement the new software will not get any of the money, now that it is used up. All medical practices have to comply with “Meaningful Use” because: Beginning in 2017, a percentage of your Medicare reimbursement will be cut off if you do not comply. Eventually you will have to conform to “Meaningful Use” if you want to receive payment from Medicare at all. Do you see where this is going?
  • So you ask: Just what is Meaningful Use? What does it mean exactly? What do I have to do? To be overly obvious, “Meaningful Use” is exactly what it sounds like. You have to have your new software implemented and put all the new features to use. This is not like most software packages where you may or may not use all the features. The government really wants you to use certain features, so they basically force you to in order to satisfy their “Meaningful Use” requirements. The requirements include the following: Gathering clear statistics on patient illnesses. Improving interaction with patients and others using the Internet. Utilizing accuracy and error control systems such as ePrescribing. And demonstrating the ability to send and receive electronic medical records with other EMR systems. These requirements are broken down into much more detailed tasks that you must accomplish, kind of like earning merit badges in the Boy Scouts!

The place to go for the source of “Meaningful Use” is:

So, for outpatient practices, the majority of my customers, here are the headings, and only the headings for Outpatient Guidelines and Requirements: (This is just the beginning Stage 1 of 3)

  1. Computerized Provider Order Entry (CPOE)
  2. Drug Allergy Checking
  3. ePrescribing (eRx)
  4. Record Demographics (new items would include perferred language, race, and ethnicity)
  5. Problem List – Maintain an up-to-date problem list of current and active diagnoses.
  6. Medication List
  7. Allergy List
  8. Record Vital Signs (including height, weight, blood pressure, calculating and displaying BMI, and plotting growth charts)
  9. Smoking Status
  10. Clinical Decision Support (CDS)
  11. Report Clinical Quality Measures
  12. Patient Electronic Data Portal
  13. Comprehensive Visit Summaries
  14. Clinical Information Exchange
  15. Protect Health Information
  16. Drug-Formulary Checks
  17. Lab Results (importing)
  18. Patient List Reports
  19. Reminders (automated reminders)
  20. Patient Access to Health Information
  21. Education (recommend appropriate patient education resources)
  22. Medication Reconciliation
  23. Summary of Care Record
  24. Immunization Registry Submission
  25. Syndromic Surveillance Data Submission

In other words, all of the features, screens, and menu options in your EHR / Practice Management Software, assuming you even have compliant software, that you set aside in order to do your real work, you must now use!

What does all this mean? It means that we all have a lot of work to do if your practice wants to continue seeing Medicare patients.

Well, as far as I can tell, there are good things and bad things in the works here. The good things are that practices must use software that includes a standardized set of information and features to help make healthcare more efficient and reduce medical errors. I am all for ePrescribing and allowing patients to see their own medical information. I am all for streamlining the insurance claims process. It is good to go paperless and be able to pass along important information in a timely manner. What I don't like is where this is all headed. This is all conveniently supporting ObamaCare and eventually a single payer medical system. I also sense that with the ease of importing and exporting EMR information that is being mandated, it could easily be misused by the government to the point where practices will someday turn over all patient information to a huge government medical database.

“Meaningful Use” looks like something that is not going to go away, for at least another couple years, at least not while President Obama is in office and we still have ObamaCare. Maybe it will go away if the political environment shifts, but we cannot count on it, and the penalty for not complying with “Meaningful Use” will start to hurt your profitability.

“Meaningful Use” is simply too important to dump in the lap of your Office Manager. It is going to require involvement at all levels, both technical and non technical, to get the job done. As always we are here to help with the technical issues.


Specific Software used by Our Customers:

Patterson Eaglesoft Dental:  Must upgrade to version 17 for Meaningful Use compliance.

Carestream / SoftDent:  Not Compliant,  They recommend you purchase and install 3rd Party Product Amazing Charts

Henry Shein Dentrix:  Need to install Connect Health module.

IO Practiceware:  Need to upgrade to version 8.1.1