The tobacco use objective: Meaningful, or just blowing smoke?

Meaningful Use is supposed be, well, meaningful.

But sometimes what's good in theory doesn't translate very well in practice.

Here's a personal example.

I recently injured my foot, necessitating a trip to the orthopedist. It turns out that the practice  transitioned from paper records to an electronic health record system since my last visit. The office still relied on paper intake forms, which is not unusual.

However, I was surprised to see on the form, a question as to whether or not I used tobacco (the answer is no). After all, smoking is not ordinarily related to orthopedic injuries. On the next line, the form explains that the reason the practice is now asking this question is "for Meaningful Use."

I was intrigued, so I asked the employee at the front desk handling patient intake what the question meant and what Meaningful Use is.

She had no idea.

Now, I know what the Meaningful Use program is and that asking about smoking status is an objective for both Stage 1 and Stage 2. To meet the objective for Stage 1, more than 50 percent of unique patients age 13 and older need to have this status documented in their record as structured data; the percentage rises to more than 80 percent for Stage 2.

As ONC explains on its website, "the simple act of asking and recording a patient's use of tobacco can have a profound benefit." It's a laudable concept.

But what's going on here is absurd.

For one, the orthopedic practice is asking this question on a paper form. The answer then has to be input into the EHR as structured data.

I don't know when (or even if) this is occurring, but it's certainly not happening in real time, so the doctor didn't have that information in front of him during my examination. He didn't even have an EHR with him.

And since I don't have to return to him for any follow up, tobacco use wouldn't be discussed in a future visit.

Then there's the problem of meeting the objective. The practice is relying on the front desk to collect this data, but this is no way to guarantee that the data is being captured. I easily could have left that question unanswered. No one checked my work to see if I had responded. That's taking a risk that the practice won't make the requisite percentages.

I hate to say it, but this process could also could adversely affect the integrity of the data. What happens if the front desk staff, realizing that patients were ignoring the question, decide to input any old data into the EHR? What's to stop that from occurring?

And while my physician knew all about Meaningful Use (I asked him about the question, too), the staffer handling the form should be able to answer patient queries about it. 

Moreover, while I understand the importance of tobacco cessation, how is the simple act of asking and recording a patient's use of tobacco here going to have the "profound benefit" that ONC is looking for? I presume the concept was that the doctor, seeing that a patient smoked, would then advise the patient to quit.

But that only works if the physician a) actually has that information during the patient visit; b) actually reads it; c) believes it's relevant to the visit; and d) bothers to say something to the patient. Is the individual, answering the question, going to say to himself, "Oh my gosh, I've just acknowledged that I smoke. How horrible of me. I must quit right away." Not likely.

What we have here is a physician's practice that has instituted an additional chore to collect data it apparently doesn't care about from a patient care perspective. It's just collecting data to meet the objective.

That's not meaningful. That's just blowing smoke. - Marla (@MarlaHirsch and @FierceHealthIT)

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