Written by: John Lynn
I love when my readers send me emails that are basically a blog post. Especially when they ask in that email to shed more light on a certain subject. Below you’ll find one such email. I’ve made it anonymous since the particular vendor doesn’t matter too much, but it’s an interesting read from an EMR vendor’s perspective.
My comment is that ONC was given the impossible task of trying to create “meaningful use” guidelines that were in fact meaningful. The concept of paying doctors for actually using the EMR is a good one, but measuring and regulating that is much harder. I’m sure many of you will enjoy the following comments about some of the meaningful use guidelines.
Some of my guys were going over the Meaningful Use requirements to feed the developers their next tasks and realized that we had missed a HUGE piece of functionality. That functionality is the Status of a “problem.” Apparently a “problem” can exist in three states: active, inactive or resolved. Notice the term “problem” is in quotes. First, there are no “problems” there are complaints, diagnoses and treatments. If there were a “problem” it would be something like “chest pain” not “essential hypertension.” The use of the word “problem” starts me down the path that the government doesn’t have a clue as to what this is or how it should work. The icing on the cake is that you don’t have diagnoses that exist in the three states that are mentioned above. Once a diagnoses has been made, the patient responds to treatment and gets better or s/he dies. This reminds me a little bit of your blog about documenting by exception. You get a ream of notes that aren’t relevant at all with every visit. Like that, if you have say chronic obstructive pulmonary disease as outlined in §170.302c, it doesn’t go away. It is a CHRONIC condition and as such will not ever be marked as inactive or resolved. The way I see it there are two kinds of visits, chronic and episodic. If I break my arm and I go get it set and have a cast put on it. This is episodic. If I have diabetes, I have to go for a visit every so often to get it checked out and maybe adjust my treatments. This is chronic. Either way, there is no doctor that is going to go back in to his own notes and mark either of these resolved or inactive on subsequent visits. That propels me far down the path of thinking that nobody making these rules really knows what they are doing. I mean the growth charts were a little piece of functionality that was difficult at best, and showed that these people don’t have the faintest idea about programming, but at least they add value.
I am seriously considering not even attempting certification for these and some of the reasons you have stated in your blog. Here is the real reason for my email: I would like to see a blog about this in the near future. Someone needs to raise his or her hand and cry “foul” before these idiots make more rules that have no meaning and only annoy those of us who do understand what is going on and what we are doing.