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High EHR Usage: Driven By Need Or Regulations?

When analyzing CMS data showing improvements in healthcare associated with EHR usage, beware "clicks for cash" phenomenon, cautions one analyst.
Michelle Holmes, a principal at ECG Management Consultants in Seattle, told InformationWeek Healthcare that she was skeptical of the claims.

"It's not to say that those benefits aren't real," she said. "But there are a lot of examples of people going through the motions to get their numbers high enough to meet the minimum thresholds so they can participate in the [EHR] incentive programs. So they're not doing [Meaningful Use] in a way that's going to necessarily lead to these results."

She cited the stage 1 requirement that EPs and hospitals share clinical summaries with at least 50% of patients after each visit. Some clinics set up trash cans in the waiting room so people can throw them out after they're printed. "Either the summary isn't configured well or the practice hasn't educated patients about why they need the information or what's there. The patient's not actually getting any value from that document."

Another example, she said, is immunization registries. "In stage 1, all the organizations had to do was send a test file to the registry. And it didn't have to succeed. It could have failed altogether. So for somebody to say, 'Meaningful Use is improving the quality of care and patient engagement' and cite the immunization registry measure, I don't think is valid."

The same goes for the CMS' claim that MU has increased efficiency. "The majority of the time, it's not resulting in an increase in efficiency, especially to begin with," she said. In fact, unless providers carefully analyze their workflows and incorporate the EHR smoothly into their clinical processes, she noted, "it's taking people more time to do this stuff."

As for drug interaction checking, she pointed out, "all you have to do is have that feature turned on. You can have your providers override every single one of those alerts, but as long as the system is enabled to do that function in the reporting period, you meet that measure."

Many organizations were able to do preventive or follow-up reminders and share care summaries with other providers, both check-off items in MU stage 1, because they were more advanced than the average doctor or hospital, she said. "It all had to do with their system capability and what they may have already been doing."

One reason why organizations might have tackled clinical summary exchange, she said, is that many physicians regard that as relevant. "It's not that 'clicks for cash' approach, but you can get them on your side in things they actually see value in."

Meaningful Use Stage 2 will provide more of the "intangible" benefits that the CMS described in its announcement, she said. For example, the requirement that EPs must share records electronically with patients and that 5% of patients must view them will require most providers to use portals. "I think that's definitely going to transform that [doctor-patient] relationship when you're required to have a certain portion of your patients communicating with you online."