One of my readers made some interesting observations about what meaningful use in a doctors office meant. It’s interesting how different people can look at the term meaningful use.

Without getting into semantics, to me the words “meaingful use” means “a way to get government money.”

Maybe I’m just a little too practical Seriously though, would we be talking about meaningful use of an EMR if it weren’t for the government money? NO. We’d be talking about all the benefits of an EMR. The use of the EMR would just be a function of obtaining those benefits. I love how a bit of money can do all sorts of funky things.

I don’t normally post press releases I receive in my email, but this one was too interesting not to post. I think many of my readers will really enjoy it, as did I.

SEEDIE Submits Meaningful Use Recommendations

SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHRs, has submitted unsolicited recommendations to HHS regarding ARRA guidance and policy around physician incentives for EHR adoption.

“What is meaningful use?” asked executive director Sal Obfuscato at a recent SEEDIE executive retreat in Belize. “We believe the question is the answer, as man has always struggled to find meaning in this world.”

This insight led SEEDIE to suggest that certified EHR vendors should embed quotes from well known philosophers in their applications. This approach will prompt physicians and other caregivers to actively seek meaning as they document patient encounters.

“When I am treating a patient, a thought-provoking quote from Jean Paul Sartre or Voltaire is far more valuable than the ability to e-prescribe or adhere to evidence-based guidelines,” said Dr. Timothy Farragut, a Vermont pediatrician and SEEDIE board member. “You get so caught up in diagnosing a condition that you forget to ask yourself the important questions – why am I here, what does it all mean, can I still make my tee time?”

These recommendations are part of a SEEDIE effort to be designated as an ARRA certification body. “Unlike certification organizations that focus on objective functional requirements, our innovative approach to meaningful use is focused on a much deeper meaning of the word meaning,” said Obfuscato.

About SEEDIE

SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s, is a healthcare IT standards organization that is completely funded and operated by a select group of proprietary electronic health record vendors.
Unlike independent, objective, professional organizations created to help medical professionals select and implement interoperable EHR solutions, SEEDIE promotes healthcare IT systems that play well in the sandbox if, and only if, it is in the best interests of a particular vendor. Learn more at www.seedie.org

I’ve been a fan of the concept of CCR since it first started many years ago. However, I’ll be honest that I haven’t followed the progression of CCR much since then.

I know that Google Health was using a modified version of CCR. I also know a number of EMR vendors that have integrated CCR with their EMR. So, I’m looking to my readers to give me an update on what’s been happening with CCR.

Also, I’ve been hearing some people refer to it as CCD instead of CCR. I think that CCD stands for continuity of care document. I assume it’s basically the document that CCR uses to share healthcare information?

At one of the conferences I attended, they suggested that CCR was the standard that was going to be used to show “meaningful use.” I haven’t ever seen the standard formalized. Did I miss this somewhere?

Ok, here’s looking to you. Leave some comments on what you know about CCR.

On my twitter stream I was getting a number of skeptics around my previous post about meaningful use and EHR certification being simplified by CMS (Medicare & Medicaid Services). They seemed a bit surprised that CMS would simplify meaningful EHR use.

Let me add a little more content and context to why Marc Probst thinks the way he does about this subject and why I wholeheartedly agree with him that MU and certified EHR’s final rules will be simpler than they are in their current form.

One of the most compelling reasons Marc gave was when he talked about a meeting he had with David Brailer. In their meeting David Brailler told Marc Probst that “Meaningful use will be a small bump in the road.” Marc then described David Brailler’s reasoning. Basically, the EHR stimulus package is only $20 billion (yes, I rounded to make the math nicer) of spending by the government after you take into account the penalties and other savings they should achieve. If you look at that spending over the number of years it will be given out we’re looking at somewhere in the neighborhood of $3 billion per year (another round number) of spending by the government. Then, the all important question:

Is CMS going to put a bunch of major roadblocks in the way of the government spending $3 billion per year on EHR?

Of course the answer could be discussed, but the point is that $3 billion in the government’s budget is nothing. Yes, I’m cringing while typing that, but it’s true. That’s why David Brailer is dead on when he says that meaningful EHR use will be a small bump in the road.

Personally, I think this is a great thing. I’ve been arguing that the barriers to this money are too high that it would be a mistake for doctors and clinics to focus too much of their energy on getting the EHR stimulus money. Now if those barriers were to lower, we’d not only see the increase in interest in EHR software, but we’d also see a significant and meaningful increase in adoption and purchase of EHR software. Then, the fun really begins.

In my ongoing series of posts from Marc Probst’s visit to Las Vegas (you can see my first post here), these next comments by Marc were really interesting.

Marc said, “The guesses are good that CMS will dilute meaningful use.”

I also asked Marc a question about whether he thought that the HHS certification criteria would be less than what CCHIT submitted as their “meaningful use” EHR certification criteria. He responded that the HHS certification criteria will be designed around the meaningful use requirements (which we already knew) and so it is likely that if the meaningful use criteria are diluted then the HHS certification criteria would be diluted as well.

What do you think of the suggestion that MU will be diluted? Which parts of MU do you think will be diluted or do you wish would be diluted?

John Halamka recently posted the following about whether doctors and practices should wait to purchase an EMR. Here’s his response:

I’m often asked by clinicians and hospitals if they should wait to purchase an EHR because of the uncertainty regarding meaningful use and certification.

I tell them to move forward now.

The following is my response I made to him in the comments of his blog:

Thanks for sharing the timeline[also included in the blog post listed above and similar to my previous post on the EMR stimulus meaningful use and certified EHR timeline]. However, I do disagree with you that people should be selecting and implementing an EHR now. There’s no rush to do this. I can agree that users should start reviewing the various EHR vendors and technologies that are available so that they are familiar with the choices that exist. However, it’s premature for those users to actually select and implement an EHR.

Your suggestion of choosing a CCHIT certified EHR is also off base. The fact is that not even the onerous CCHIT certification criteria meets the meaningful use matrix that you reference. So, the certification criteria will change and it’s likely that not all CCHIT certified EHR will achieve HHS EHR certification (which is what really matters for the $$).

Instead, the wisest counsel that can be given to providers is to select an EHR based on which EHR software will best meet their business needs. If they do that, then whether they’re able to get the EHR stimulus money or not they’ll be happy with the decision they make. The EHR stimulus money will just be a nice bonus if it all works out well.

What do you guys think? Is the time now to purchase an EMR?

Ok, I know I should see this coming and just expect it. However, it doesn’t make it any more right or me any more upset that this kind of shady practices occur.

Yes, today I received my first notification that some EMR Consultant…errr…should I say Meaningful Use consultant…err…should I say liar…was giving detailed recommendations to a practice on how to meet meaningful use. The sad part is that the practice didn’t know that nothing is final with meaningful use and may not be until middle of 2010 and so they were handing over their money.

Looks like I need to add meaningful use consultants to my list of Big Winners from the ARRA EHR stimulus money. Of course, if you’re reading this blog, you’re not likely to be the one being duped. So, tell your friends that we still don’t have a final rule for meaningful use or certified EHR. Anyone that tells you so should be kicked out of your office immediately.

I’ve gotten a couple emails from people suggesting that I should write about the current and potential EMR backlog that is happening in the healthcare IT industry. It’s something I’ve discussed tangentially when talking about EMR and the ARRA EMR stimulus money. Basically, some EMR companies have been making the case that doctors and clinics need to make there EMR selection now in order to avoid the EMR backlog that will occur for an EMR vendor once we know the full details of “certified EHR” and “meaningful use.”

Dr. Jeff at EMR and EHR pointed me to a section of the newsletter by XLEMR that provides another perspective on the EMR backlog.

Once preliminary certification begins in October, EHR demand should surge. Although the market is currently slow, many vendors have installation backlogs. Preliminary certification may cause those backlogs to increase. Physicians who are in the “wait and see” mode will need to make a decision quickly. Waiting could result in long delays that may jeopardize the ability to qualify for the first year of reimbursements. One alternative is to purchase a simple system. Simple systems take much less time to install, so backlogs are not a problem. Simple systems are also easier to learn, meaning you do not use as much valuable time for training instead of seeing patients. Finally, simple systems are easy to use, giving you more time to qualify for meaningful use. Be sure to ask any EHR vendor if they have any backlogs, and how long it takes to implement their system. Their answer will tell you if their system is simple.

This type of tongue and cheek style of writing is right up my alley. It makes a really interesting point and you can’t help but laugh when you get to the end.

Some might argue that the EMR is so good that the demand for it is so high and that’s what creates the EMR backlog and not the fact that the EMR isn’t simple to use and requires a lot of training and work to implement. I’d suggest that the EMR backlog is probably a combination of high demand for that EMR and the EMR not being very easy to implement/use. However, the high demand for most of the EMRs with a backlog has little to do with how great the EMR is and has more to do with that EMR company’s ability to market and sell their EMR.

John at Chilmark Research posted a note about the importance of how ONC and HHS define the terms “meaningful use” and “certified EHR.” I wanted to echo his comment so here it is:

Note: We can not emphasize enough just how important these two terms (meaningful use & certified EHRs) are to the market. These terms will literally define the HIT market for the next decade and whether you are an HIT vendor or one looking to adopt an HIT solution, having a clear understanding of what these terms mean and their implications will be critical to your success.

Basically, the $36.3 million in EHR stimulus money is dependent on “meaningful use of certified EHRs.” That’s a lot of money and influence on two terms. I hope as many people as possible will participate in today’s HIT policy committee meeting which should work to define “certified EHR.”

A relatively new reader of EMR and HIPAA, Michael Archuleta, sent me his notes from the Utah Medical Group Managers Association 6/25/09 where the keynote speaker was Marc Probst. For those that don’t know, Marc Probst is the CIO of Intermountain Healthcare (IHC). IHC is huge in Utah and I think it does pretty well in a number of surrounding states as well. Plus, Marc Probst is also a member of the HIT Policy Committee. You may remember that I’ve talked about Marc Probst on EMR and HIPAA a few times before.

Anyway, I found some of the points that Michael captured interesting. I guess in the end I was interested to hear what Marc Probst was telling people. Michael Archuleta’s notes are as follows (published with permission and the emphasis added was mine to highlight some interesting parts):

Mark Probst – Intermountain Health Care – government wants to invest 42 billion in IT healthcare. IHC has 500,000 enrollees, 28,000 employees. 600 physicians. They are a unique integrated health care organization. Feels Obama framed the problem (related to health care, in previous nights TV pitch) well, and wants his plan in by Oct 09. Referred to how IHC is the lowest cost per capita.

Probst has met with 3 congressman and 20 government staffers. Using Mayo Clinic as a benchmark, could save 30 pct in chronic illnesses. There are 300,000 uninsured Utahns.

Four stages of an EMR. Third stage was commercial products. Stage four will have broad adoption of solutions. Second increased knowledge. Third is introduction of clinical decision support. A stage 3 EMR could save a 300 bed hosp at least 11M.

At LDS hospital there were 581 adverse drug events in 1990 and in 2004 there are only 270 . Their stats showed that waiting to 39 weeks (for OB delivery) was best for infants and reduced neonatal admissions. The docs said they knew this already and didn’t induce unnecessarily. But when showing them the data, they were in fact inducing. The same stats showed improved outcome with acute respiratory stress.

150 people are working on a new EMR system (for IHC) with GE and people from India. A complete clinical information system has automation (taking common tasks and automating it like voice, scanning, bar codes. Helps you with inventory management and pricing. Provides automated data entry with hot texting.), connectivity (using a network. Allows doctors to see and share information and this brings more specialists into the picture.), decision support (prompts and alerts for obvious things. Advanced decision support like glucose management and need to push the human mind.), data mining (using historical data to identify patterns and to test hypotheses).

Commercial systems were good at automation and connectivity but were weak on decision support. IHC was good in that area so they decided to build their own hybrid.

Rather than rip and replace, they aggregate, view, analyze, alert and then gradually replace existing systems.

The government HIT policy committee: Meaningful use says that to get money you need a certified system and have meaningful use. There must be a certification and an adoption. Must have the ability to do health information exchange. Time frames are aggressive: They originally thought they had until October to define requirements and then were told by the Obama administration that it was moved up to July 16. It will move from policy to a standards committee.

The intent and commitment of the people involved on the HIT committee is to do the right thing.

Questions from the floor: Doesn’t HIPAA preclude the ability to share information? In his opinion it allows for protection.

How do we get our voices heard? Have to get involved with AMA.

What is meaningful use? Capture discreet data like BMI, weight. Then there is an adoption process.

How will costs go down? If other things are in place, then we will minimize duplications. We may be connected but we can’t talk.

What about CCHIT? It is unclear what their role will be. IHC, for instance, is a hybrid of best of systems. Who would certify us?