[TriLUG] OpenEMR, Electronic Health Records, Meaningful Use and trouble.

[Charles Fischer via TriLUG]

If this steps over the line for being open source related, sorry.

I am trying to get some movement on the absurd meaningful use requirements
for electronic health records.  Tying this to open source is the problem of
open source software meeting government requirements that are strongly
influenced by proprietary software vendors.  In this case OpenEMR is not
used much in the US, but has good usage elsewhere.  The main problem
OpenEMR (http://www.open-emr.org/) has is meeting meaningful use
requirements.  The founder of Epic (one of the largest EHR vendors) was on
the committee that set the standards.  Please sign the petition at:

http://wh.gov/iAvRx

Then foreword this e-mail to as many people as you can.  Following is an
e-mail I sent to friends, it has a lot more information:

About two weeks ago I attended a webinar about Meaningful Use (MU) and
Electronic Health Records (EHR).  The needless hoops that a small medical
practice needs to jump through to avoid paying a penalty on their Medicare
patients is absurd.  So absurd that I wrote to my US Congress critters that
night.  I am still pissed, so the next step is a “We the People” petition.

I need 150 signatures before the petition is search-able and visible to the
public.  Please follow one of the following links and sign the petition:

http://wh.gov/iAvRx

https://petitions.whitehouse.gov//petition/end-penalties-not-meeting-meaningful-use-mu-requirements-electronic-health-records-ehr

After signing the petition, please forward this e-mail to as many people as
you can.  For the petition to be acted on, it needs 100,000 signatures in
30 days.

Disclosure: I do have a financial interest in EHR integration.  If the
penalties are dropped the odds are it will cost me.  That does not change
my mind about dropping the penalties being the correct thing to do.

Following is the message I sent to my Congress :

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Dear Congress Critter;

I am an information technologist that helps ophthalmology practices
implement Electronic Health Record (EHR) systems.  I attended a webinar
about meaningful use today and that prompted this letter.

Medical practices are having to implement severely flawed systems costing
both money and efficiency.  One small study (
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712610/) showed a 16.9%
decline in patients at an eight physician academic clinic over a four year
period.  None of the eight doctors were able to return to their pre-EHR
patient visits after four years.  In a typical private practice a 16.9%
 reduction would be about five patients per doctor per day.

In my experience flawed meaningful use requirements are a significant
reason for the drop in efficiency.  For example ordering a common Optical
Coherence Tomography (OCT) test went from telling the technician to do the
test, about 5 seconds, to having to order the test through the EHR system's
Computerized Physician Order Entry (CPOE) module.  If the test is not
ordered though CPOE, it is not be counted for meaningful use.  I timed
ordering an OCT last year at 55 seconds.  For a typical visit the 50 extra
seconds to order an OCT represents a 7% drop in efficiency.  CPOE makes
sense in a hospital or a large practice, but not in a small practice where
the doctor and the technician are close enough to talk to each other.  As
for keeping track that the OCT was done, that is easy, as the results of
the test must be entered into the EHR for billing.  There are many other
examples of delays caused by flawed requirements for test and lab results
to be documented before and after the tests are done.

The great promise of EHR systems was that a patient's records would be
accessible from any medical practice, eliminating the need for duplicate
tests and data entry.  The data could also be used by researcher looking
for clusters of cancer, disease outbreaks, prescription drug abuse and even
terrorist biological and chemical attacks.  The problem is that the
infrastructure for sharing the data does not exist.  The first two stages
of meaningful use just added to the problems of duplicate tests and data
entry, because it required doctors to pester patients for data that was not
necessary for the patient's current visit.  An example would be having to
ask a patient about smoking when there is a stick in the patient's eye.

The Center for Medicare & Medicaid Services (CMS) made huge mistakes when
they setup meaningful use for EHR systems.  The head of CMS, Andy Slavitt
seems to know that there are and were problems, but does not know that the
meaningful use ship need to be turned around now.  One of the small
practices I work with is about to decide if the 3% penalty (about $100,000)
is a better deal than spending the money, time and frankly the pain in the
rear that meeting meaningful use in 2016 would cost.

Sometimes programs are so messed up that the only way to save them is to
start over.  Meaningful use is a shining example of a program that needs to
die and be reborn.  The death of meaningful use has many supporters.
Please do what you can to kill the current and near future implementations
of meaningful use that CMS has in place and is contemplating.  The rebirth
of EMR meaningful use should concentrate on sharing data.  Until the
significant problems of a data sharing infrastructure are solved and
implemented, there should not be any penalty for medical facilities not
meeting meaningful use requirements.

Thanks,
Charles Fischer

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If you have questions about why you should sign this petition, let me
know.  If I do not know the answer, I will try to find it.

Please, please forward this e-mail to everybody you know.  100,000
signatures is going to be hard.

Thanks,
Charles Fischer