A Patient’s View of Meaningful Use

Meaningful Use (MU) is a concept that came out of the Medicare and Medicaid EHR Incentive Programs and a patient’s view of meaningful use is difficult to find.  Through carrots (incentive payments) and sticks (non-compliance penalties), the Meaningful Use program convinced many healthcare providers and hospitals to adopt several measures that benefit patients and deliver healthcare value. If you ask the average American in the street what Meaningful Use means, you would probably be greeted with blank looks. The various terms that have come out of Meaningful Use (see the figure below) are even more obscure. This is not surprising given the fact that over the past six years, all Meaningful Use program details were thrashed out between our government and healthcare providers. Patients were not invited to contribute and strongly discouraged to take any part in it.  In this blog post, I will present a patient’s view of the meaningful use program.

A Patient’s View of Meaningful Use

While our government is currently in the process of mothballing the concept of Meaningful Use, it is important for patients to understand that the products of Meaningful Use must endure beyond the program.  These products are the foundation for improved coordination of care, reduced healthcare costs, and improved patient outcomes. Meaningful Use is based on the sharing of health records with patients (and those they designate) and the patient is at the center of Meaningful Use.  If your healthcare provider has chosen not to participate in the Meaningful Use program, then you probably have not seen the healthcare improvements I will describe in this blog post. I would recommend you seek other healthcare providers that do participate in Meaningful Use and are committed to electronic sharing of the health records in their possession.

a patient's view meaningful useMeaningful Use has opened patient health records locked away in thousands upon thousands of healthcare businesses across the country for use by patients for better health care. Three areas positively impacted by Meaningful Use requirements include:

  1. Patient safety and treatment
  2. Communication (Provider-patient and provider-provider)
  3. Shareable Electronic Health Records

Patient Safety and Treatment

Our government has known for a long time that the healthcare treatment many Americans receive is sub par (link to quality of care blog post) but “making” doctors improve their medical practices is not an easy task in the United States. Doctors function as private businesses, are in short supply, and, short of committing flagrant malpractice, are free to provide less than high-quality, evidence-based care without fear of losing business. Meaningful Use is one program where our government is attempting to bring better healthcare practices to patients.

Some of the Meaningful Use improvements are behind-the-scenes medical practice changes.  Replacement of paper health records with Electronic Medical Records (EMRs), has streamlined record retrieval and reduced human error possibilities (e.g., missing and misplaced charts, out-of-order files, unreadable information).  These files are the foundation for continuation of care and their accuracy and completeness is crucial for best patient care.  In addition, your provider is now ordering blood tests, various tests (xray, ct-scans, etc), and prescriptions electronically. This is called Computerized Provider Order Entry (CPOE). It reduces the likelihood of errors associated with reading and transcribing hand-written orders and improves patient safety.

Some of the improvements are both behind-the-scenes and directly engage patients.  The Clinical Decision Support (CDS) objective of the Meaningful Use program is our government’s way of bringing the power of digital information to the healthcare business.   The Clinical Decision Support system electronically delivers documentation templates, condition-specific order sets, focused patient data reports and summaries, diagnostic support, and other reference information for use by the healthcare provider.  It comes with computerized alerts and reminders for providers and patients. For example, if a healthcare provider electronically orders a prescription that interacts with drugs you are already taking (or requires a different dosage because of kidney or liver disease in your history), the CDS system generates a pop-up alert to the healthcare provider to change. The CDS system eliminates many potential human errors by using patient data (like the patient’s weight and past drug history) to ensure the correct medication dosage is prescribed.  If the healthcare provider does not come to the medical information, CDS guarantees that it will come to him and his patient.  Electronic data to the rescue! The various elements of CDS are effective only if the private healthcare professionals chooses to use them.

The timely Clinical (after-visit) Summary Report is another Meaningful Use improvement to the longstanding practice of medicine in the United States. Included in the Clinical Summary documentation (currently available in the business-centered EHR patient portals) is important patient safety information (your medications list and drug allergies) that can be consulted in an emergency situation when time is of the essence and lack of this information can be life-threatening. This report documents the healthcare visit for patient inspection and its completion demands that healthcare providers think through the health care they administer before, during, and after the typical 15 minute office visit.

Patients can correct errors or omissions and use the Clinical Summary to engage after the visit in many ways. Before Clinical Summary Reports, patients often left hurried office visits without having a clear picture of what was required of them post-office visit and without a clear understanding of their condition.   The Clinical Summary addresses all these issues and forces the healthcare provider to address optimum patient care instead of just quick patient turnover (to maximize income). Maximizing patient outcomes is often as much about what happens after the office visit as what happens during the 15 minute visit.

Communication (provider-patient and provider-provider)

Communication between patients and their healthcare providers and between providers is critical to achieving the “best” patient outcomes.  “Best practice” guidelines may direct the healthcare professional to the best possible evidence-based outcome, but each individual patient brings to the table unique needs, preferences, and values that impact what they are willing and able to do.  In the former fee-for-service business of healthcare environment, communicating with patients took time that could be better spent generating billable codes. Meaningful Use forces healthcare providers to communicate with patients. When filling out the Clinical Summary report described above, the healthcare provider must talk to the patient to get the required information. Since Clinical Summary reports have become a part of my healthcare providers’ practices, I now feel like they are looking at me as more than a collection of parts.

Online messaging capabilities within the business-centered EHR patient portals allows me to read the Clinical Summary report at home and if I have questions about the care or instructions, I can easily send off an email message directly to the healthcare provider (or staff) and wait for a response.

Before Meaningful Use, healthcare providers rarely communicated with each other for coordination of care. Courtesy reports to a patient’s general practitioner were not common. Each provider treated their “part” of the patient and left the other “parts” to the appropriate specialists. With Meaningful Use, healthcare providers have been incentivized to use email and direct sharing of electronic health records for coordination of care communication.

Shareable Electronic Health Record

If you are one of the patients who signed up for one of the many healthcare business-centered EHR patient portals, then you may have seen Electronic Health Records waiting to be shared. To date, only Clinical Summary Reports, a small fraction of the patient’s Protected Health Information in designated record sets has made its way to the EHR patient portals for sharing. Many After Sickness healthcare situations (especially for more serious illnesses) involve multiple caregivers.  Readily available patient health records for coordination of care improves the patient’s chances for a better outcome. Several healthcare professionals actively coordinating care is a much better practice than individual healthcare providers providing separate diagnoses /treatment plans running independently. This coordination of care reduces healthcare costs by eliminating over-testing and over-treatment.

The Bottom Line

From this patient’s view of Meaningful Use, it is important to understand that the products from this program serve as the foundation for improved coordination of care, reduced healthcare costs, and improved patient outcomes. Some of these Meaningful Use changes have directly improved the behind-the-scene medical practice of our healthcare providers (Computerized Provider Order Entry (CPOE), Clinical Decision Support (CDS) and e-prescribing). Other changes engage patients for improved outcomes (CDS, shareable electronic health records, electronic messaging). While the Meaningful Use program was designed and implemented by our government, healthcare providers, and hospitals, the patient is in fact the primary beneficiary of Meaningful Use.

The government program that gave us Meaningful Use may be ending from a funding standpoint, but members of BB’s Brigade understand that its benefits must live on.

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