Explore This IssueMay 2010
Another problem is that many of the meaningful use criteria don’t apply to what specialists do on a day-to-day basis, said Dr. Kotler, past chairman of the Medical Informatics Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). For example, the proposal would require physicians to record changes in blood pressure and body mass index (BMI) for 80 percent of patients, as well as plot growth charts for children aged two to 20.
In addition, physicians would have to report both core clinical measures and measures in a defined specialty group. Otolaryngology is not among the 15 specialty groups, which include primary care and proceduralist/surgeon. The specialty measures don’t mesh with what otolaryngologists do in their practices, Dr. Kotler said.
The AMA recommends that the core measures be dissolved and moved to the primary care specialty measures group and that the rule then be changed to allow doctors to attest that they are using at least three clinically relevant quality measures. According to the organization, if three clinically relevant measures cannot be identified among the specialty groups, physicians should be able to attest that zero, one or two measures are applicable.
The proposed regulation also requires physicians to be able to communicate electronically with others. At least 75 percent of all permissible prescriptions written by a physician would have to be transmitted electronically using certified EHR technology. But not all pharmacies have electronic systems to receive e-prescriptions, noted Dr. Kotler and the AMA.
The burden of meeting the meaningful use criteria is another concern. One major problem is that the interim final regulation for federal certification of EHRs doesn’t require that the software be designed in a way that allows physicians to meet the meaningful use criteria, Dr. Kotler said. If a physician’s EHR doesn’t have a function to automatically pull out patients’ BMI data, for example, the doctor or a staff member would have to go through EHRs and manually extract that data to meet the meaningful use criteria, Dr. Kotler explained. “It would be so much better and more efficient if you could literally click a button on your EHR, and it would extract that information out in the format that CMS wants, and then just send it to them electronically,” he said. “But no vendors have that functionality yet.”
The rule sets out two incentive programs for meaningful EHR users, one for physicians participating in Medicare and the other for physicians who meet a Medicaid patient threshold, generally 30 percent of patient volume. On the surface, the payments appear reasonable, Dr. Kotler said. But considering that implementing an EHR is more than just buying and installing software, the payment size falls short, he said, explaining that after installation, physician practices can’t handle their normal patient load for up to six months while the staff gets up to speed.