Why Meaningful Use is 'impossible to meet' for pathologists

Pathologists are enthusiastic, heavy users of health IT, but the vast majority of them don't use electronic health records or work in environments where they can meet the requirements of the Meaningful Use incentive program, which is setting them up to fail when penalties for non-attestation kick in in 2015.

David Booker, M.D., member of the board of governors of the College of American Pathologists (CAP) and chairman of its clinical informatics steering committee, shared his insights on the program and the Centers for Medicare & Medicaid's proposed hardship exemption in an exclusive interview with FierceEMR.

FierceEMR: The CAP has been advocating that pathologists' hardship exception, exempting them from the Meaningful Use program through 2014, be extended further. Why should they not be part of the program?

David Booker: The real emphasis of the program is on primary care providers and others using paper charts. Pathologists are not the appropriate target. The measures don't fit. They're not doing prescribing or checking blood pressure.

Not only that, but they don't use EHRs. They use Laboratory Information Systems (LISs). It's like requiring people in South Florida to demonstrate that they're competent in the use of snow blowers. It's impossible to meet Meaningful Use as written.   

FierceEMR: Have any pathologists attested to Meaningful Use?

Booker: A tiny percentage of pathologists have attested, but even then they're not performing quality measures; they're bundled with the rest of the medical staff.

Pathologists are not asking for subsidies because they're not buying EHRs. Most pathologists don't own or control their health IT. They just don't want to be penalized. We want a fundamentally flawed approach ended.

FierceEMR: Why ask for an extension of the hardship exemption? Wouldn't it be more efficient and less complicated to simply remove pathologists from the definition of eligible professional in the statute so they're don't even participate in the program itself?

Booker: CMS and ONC [the Office of the National Coordinator for Health IT] believe that it's beyond their control to change the law because of the way the law is written. They say it doesn't give them the flexibility.

FierceEMR: What about interoperability between pathologists' LISs and EHRs? Can they share data, which is a requirement of the program?

Booker: We're happy to work on interoperability with EHRs. We're very interested in interoperability and increased interface between EHRs and LISs. But we have no control on how to make it happen.

FierceEMR: Are there other ways pathologists could contribute to health IT and the Meaningful Use program?

Booker: We should be permitted to participate in the development of EHRs for functionality to be where it should be. We're very interested in ensuring that lab information is properly displayed in EHRs.

We've been trying to get vendors to work with pathologists more, but vendors will put in lab functionality [into the EHR] without pathologist input. We're often not invited to the table.

Editor's Note: This interview has been condensed for content and clarity.

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