Meaningful Use

Being someone who is enamored with technology, I always have to remind myself that the EMR is just a tool. You can have a technically perfect implementation, with a flawless go live, high adoption rate, unerring interfaces and charts billowing with entered data, but not provide value to the the patient or the community. At the end of the day, this tool has to produce results, and these results, in my opinion, have to show an improvement over the current health status of the community and the individual patient; otherwise, why bother?

Improving health reduces cost and increases productivity (of the patient). Registries have got it right in focusing on data proven to be correlated with decreased morbidity and mortality, like HgbA1C, lipid profiles, eye/foot exam frequency for diabetics, weight for congestive heart failure patients or peak expiratory flow rates for asthmatics. Different practices have different demographics, and therefore have different disease profiles, but all have their share of the top 5 or 10 chronic diseases. Meaningful use should include improvement in metrics proven to make a difference with our 20% disease classes which take up 80% of our resources.

Meaningful use should also address our problems of high readmission rates, redundant or excessive use of diagnostic tests (I would refer everyone to the insightful article in the New Yorker on one of the culprits of rising health care costs: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande) by requiring improvements in these metrics. Along the same vein, meaningful use of ePrescribing should consider measurements of medication errors, call backs to providers for verification, cost of medications prescribed and rate of iatrogenic medication interactions.

We should not be interested, nor accept, in replacing an ineffective paper chart with an ineffective digital record. Meaningful use should be at the forefront of changing the health care system to a sustainable, prevention oriented paradigm of care.