Meaningful Use Part Deux

The AMA News is listing some of the changes to come upon us in 2014.

Here are what EMRs will be expected to do in Stage 2 of the Meaningful Use criteria.   Some optional EMR functionality objectives in stage 1 would become mandatory in stage 2. Overall, physicians would need to use their EMRs to meet 20 functionality objectives at minimum levels to earn bonuses and avoid penalties.  I put in bold the ones I consider very questionable.   Patient portals and secure messaging sound great unless they are not paid for, which they are not.    Okay, take a look at the never ending hoops that are being added on and remember, it never ends.  

Core set (must meet all)

  • Use computerized physician order entry for medication, lab and radiology orders
  • Prescribe electronically
  • Record patient demographics
  • Record and chart vital signs
  • Record smoking status
  • Use clinical decision support
  • Incorporate clinical lab results into EMR
  • Generate lists of patients by specific condition
  • Set patient reminders for preventive and follow-up care
  • Provide patient portal access
  • Provide clinical summaries for patients
  • Identify education resources for patients
  • Use secure messaging with patients
  • Use medication reconciliation
  • Send summary of care records for referrals and care transitions
  • Send electronic data to immunization registries
  • Ensure EMR privacy and security

Menu set (must select and meet three)

  • Access imaging results
  • Record patient family histories as structured data
  • Send electronic syndromic surveillance data to public health agencies
  • Have ability to report cancer cases to state registries
  • Have ability to report noncancer cases to specialized registries

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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12 Responses

  1. mM Evil EHR says:

    Stop crying about patient portals. The ones built correctly are passive – i.e. push data out to patients from your EHR. Why shouldn’t patients have access to their health data easily? Also – secure messaging done well has 75% of messages handled by staff and reduces phone tag. Say it can’t be done? Our 500+ MD group has practice-wide secure messaging. We have over 75K patients signed-up and MD’s average 6-8 messages a day – 2-4 of which they have to answer personally. Patients LOVE it and do not abuse it. For the few who do – we delete access to messaging and the patient advocates work with them. Yes, our docs thought this would be the end of Western Civilization 2 yrs ago – today is is ho-hum business as usual. Not every change is awful… sure they think they should be paid for messaging but they think the same for phone calls…

    • Doug Farrago says:

      EHRs are great. Patient portals could be great. The money needs to go to the doctor and not the middle men. A paradigm shift would take care of all of this. It is called Direct Pay.

    • Bridget Reidy MD says:

      I’m sure when the phone became ubiquitous and doctors agreed to answer them for free it was rarely overused at first. And when patients needed forms filled out and other non billable services and they started doing those for free it was not a lot of extra work right away either. And when insurance companies said we’ll pay your bill and now you need a biller to learn a few of our tricks, there weren’t that many tricks at first either…

  2. big picture doc says:

    Primary care has been dumped on from the beginning. That’s because we let it happen.

  3. DrHockey says:

    I do not know any physician who “loves” his/her EMR. For everyone who “likes” their EMR, there seemingly are a gazillion who hate it. For those who do like their EMR, the other consulting physicians reading those reports despise it.
    Seems like a win-win situation to me?

  4. Burton Mendel says:

    The most frightening line in this list is the following:
    •Ensure EMR privacy and security
    The Pentagon and NATO cannot create a hacker-proof computer system, but the medical care industry is supposed to do so.

  5. William Bodenheimer, MD says:

    I already determined that PCMH would be impossible in my single physician small practice. I see very little medicaid and stopped taking new medicare two years ago. I am hopeful that when all of this comes down in 2014, that I can tell the gov’t to kiss my ass and drop all gov’t insurance.

  6. Ann Deluty says:

    I was wondering why I suddenly got email about a website (patient portal system) from my Dentist and PCP. What a waste.

  7. lkutner says:

    Is “patient portal access” related to the earlier story about Hawkeye and the pig? That would be an impressive EMR feature!

  8. CancerDoc says:

    This is why docs are so tired. Remember, when patients complain about the fact that their primary care physician is no longer rounding in the hospital so that “strangers who don’t know my case are messing me up”….it’s because the office based physicians are worn out from all the data that they have to manage, much of which has very little to do with actively taking care of the patient. When a patient comes to me for metastatic small cell lung cancer, setting up reminders for “preventative care” is a little bit unnecessary (and wasted). So far, our EMR doesn’t have a button to click for “not indicated.” Sigh.

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