Has the Meaningful Use program run its course?

Meaningful Use: It's just like high school, where you learned all the right facts for the test, but the knowledge didn't stick with you any longer than until the end of the semester. At least, that's the opinion of Dale Sanders, former CIO of Cayman Islands Health Services Administration and current senior vice president for strategy at Health Cataylst, writing in a post at healthsystemCIO.com.

"... [L]ike a teacher who 'teaches to the test,' the program created a very complicated system that might pass the test of MU, but is not producing meaningful results for patients and clinicians," Sanders writes. "It's time to put an end to the federal MU program, eliminate the costly administrative overhead of MU, remove the government subsidies that also create perverse incentives, and let 'survival of the fittest' play a bigger part in the process."

MU Stage 1, Sanders says, "created a false market for mediocre products."

In particular, he writes about one project he participated in--an EMR Utilization Dashboard, and a simple document that outlined core principles of EMR utilization--that showed great success over two years. Some of those "core principles of EMR utilization" developed include:

  • Log all "encounters"--appointments, visits--in the EHR
  • Medication and prescription refills must be documented in the EHR; and medications should be reviewed at every encounter
  • All chronic conditions and allergies should be logged in a "problem list" in the EHR
  • Progress notes and patient messages must be logged in the EHR; patient messages must be reviewed within 72 hours

Although one of the main goals of the Meaningful Use program is to improve the quality of care, there appears to be "no association" between being a "meaningful user" of EHRs and the quality of care provided to patients, according to a recent study published in JAMA Internal Medicine. The researchers studied the treatment of adult outpatients at Brigham and Women's Hospital and affiliated ambulatory practices during a 90-day reporting period in 2012 to assess if there were quality improvements on seven measures for five chronic diseases: hypertension, diabetes mellitus, coronary artery disease, asthma, and depression. All of the physicians used the same advanced EHR.

Meanwhile, Meaningful Use attestation has been uneven, according to research published last summer in Health Affairs, with smaller and more rural hospitals struggling to meet the incentive program's required thresholds.

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