You know, I’ve been thinking a lot about Meaningful Use lately. I previously I’ve had pretty negative opinions of it, and my thoughts seem to be echoed by a lot of doctors currently in practice.
Rob Lamberts, MD, wrote an interesting post titled Ten Ways to Make the EMR Meaningful and Useful. I have to admit, his suggestions made an awful lot of sense. They started me thinking about how useless much of my own documentation is because of its origination in archaic rules for receiving insurance reimbursement money. Unfortunately, it seems that a lot of these rules stem from the medical profession itself rather than have been having been thought of exclusively by insurance moguls. For example, the family history is usually almost entirely irrelevant to what my scope of practice generally entails. The Review of Systems (ROS), which is the part of the exam where we as doctors ask the patient a myriad of questions regarding their symptoms, is typically exhaustive, unproductive and usually despised by most practicing physicians. Patients are generally very forthcoming about any active symptoms that they are currently experiencing, and a few additional questions around their symptoms typically suffices for a doctor’s purposes.
The majority of old medical records that I get from previous practices in which the patient has been involved are usually either illegible, irrelevant, or not directly related to the reason the patient is coming in to see me. If I am seeing them for the same purpose and they are just transferring their care to me, I generally will ask much of the same questions that have been asked before, rendering the review of records of even more limited value.
I think that getting meaningful use out of our own individual records could be greatly helped by an overhaul of the medical profession’s recommendations to insurance companies on the types of information that needs to be included in medical office notes for the purposes of providing excellent healthcare. In the increasingly complex and technologically-advanced society in which we live, information “noise” really should be kept at a minimum, especially in providing appropriate healthcare recommendations to patients. Medical records should not be in a habit of containing information that does not change or impact the medical management of the patient. We really need to revisit the idea of “gee whiz” type of data and cut out any extraneous documentation.
This would, of course, require that meaningful use become much more personalized and individualized to specific doctors and their specialties. The current state of meaningful use is actually fairly limited in that it applies mostly to primary care providers making recommendations for preventive health care. Preventive health care, unfortunately, is almost never the reason why patients seek the advanced medical knowledge of specialists and subspecialists in specific areas of medicine.
In summary, I agree with Dr. Lamberts that we need to overhaul meaningful use into something that is much more meaningful and usable.