Certainly we can all agree that regulations, stimulus money, policy, and our own medical practices are in a vortex of confusion. Like flotsam swirling in a whirlpool, acronyms mingle with legislative labels and position points. There is real value swirling around with the flotsam, but it’s difficult to sort out as it spins.

One of our customers asked if ClickCare had “meaningful use.” Our first thought was, of course it’s meaningful–that’s the whole point. If we empower medical providers to collaborate among themselves in a simple and easy manner, everybody wins. Most importantly, patients win, but providers win too.

Providers know they’re doing the right thing by working together, and they see that it’s not so hard. Indeed, collaborating with ClickCare is easier to than playing telephone tag, even if you need to slow down for a few seconds to take a picture and write a brief history and question.

Obviously, that is meaningful, so what is this meaningful use talk? We decided to look into it.

First, we found out that “meaningful use” is a buzzword that only applies to Electronic Medical/Health Records. While ClickCare augments and enriches EHRs, it is not an EHR. ClickCare is a collaborative tool to help you get through the day better. The proposed EHR rules and buzzwords do not apply. However, we dug deeper, and here’s what we learned.

All of the proposed rules boil down to the government wanting to have some type of warranty on what they bought with the money that they have spent on EHRs. They are offering money to hospitals and physicians as part of the stimulus program to encourage implementation of EHRs/EMRs.

These are the current objectives for meaningful use:

2011 objectives

Despite some revisions, most of the initial recommended requirements for physicians receiving EHR stimulus money remain the same. By 2011, physicians will be considered meaningful EHR users if the practice meets multiple objectives, including:

• Maintaining an active medication list.
• Incorporating lab test results into the EHR as structured data.
• Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach.
• Reporting ambulatory quality measures to the Centers for Medicare & Medicaid Services.
• Sending reminders to patients for preventive and follow-up care.
• Documenting a patient progress note for each encounter.

These objectives are structured for the time being as awards and bonuses for early adopters. Later on, however, penalties are planned for non-adopters. Thus, in 2013:

2013 requirements

• Specialists must report to relevant external disease or device registries that are approved by CMS. This was not in the initial draft.
• Hospitals must conduct closed-loop medication management, including computer-assisted administration. This was not in the initial draft.
• All patients must have access to a personal health record populated in real time with health data. This was moved up from 2015 in the initial draft.

Additional provisions

• Patients’ access to EHRs may be provided via a number of secure electronic methods, such as personal health records, patient portals, CDs, or USB drives.
• CMS will determine how submitting electronic data to immunization registries applies to Medicare and Medicaid meaningful use requirements.
• CMS may withhold federal stimulus payments from any entity that has a confirmed privacy or security violation of the Health Insurance Portability and Accountability Act, but it may reinstate payments once the breach has been resolved.

Of course, all of these requirements and provisions are engendering a lot of comment, and the final rules have not been published. In the meantime, don’t let proposals and legislative initiatives get in the way of what we are all trying to do–provide better access to care for patients, collaborate to benefit all concerned, and educate each other and those who are coming up after us.

Further reading

The information in this article is summarized from:

http://www.ama-assn.org/amednews/2009/08/03/gvsb0803.htm

This is the letter of guidance to state medicaid directors from CMS: http://www.cms.hhs.gov/smdl/downloads/SMD090109.pdf

Here is a brief slideshow by Michael Duffy from Health IT Advisors. We found it helpful, but do not have any relationship with him. http://www.slideshare.net/HITadvisors/ehr-meaningful-use-onc-policy-commitee-june-16-2009
Lawrence P. Kerr, MD, FACS is a reconstructive surgeon practicing in Binghamton, New York. With his wife, Cheryl Kerr, MD, a pediatrician also in private practice, he is the founder of “Click Care,” an online wound care consultation service. Contact the author at www.clickcare.com.