Meaningful Use Misery

By: Georgia Newman, MD

I am not a meaningful-use neophyte, having met the Stage 1 rules in 2011 and again for all of 2012 and again in 2013. So, by spring 2014, I had collected $36,000 of the purported $44,000 to be given by CMS to hardworking doctors using technology "meaningfully." Now facing the Stage 2 rules, I was confident, even though:

• The reward is now only $4,000 for completion;

• The measures were in flux right up to July 2014, when the final rules were set; and

• Everyone was bitching that the measures were going to be unreachable.

In fact, as it turned out, many of the measures involved people, places, and things, not under control of the doctor: me.

I started out with the assistance of the EHR team. One of the measures involves transmitting a patient summary to a non-identical EHR. I had to obtain a direct address, then sign up with something called HISP (Health Information Systems Program), then send a test patient record. It went right off to someplace in Massachusetts. Done and done.

Next hurdle: Sign up to send immunizations to the state registry in Ohio. Many confusing forms later and e-mails back and forth over three months, I was listed as meeting the "intent to send immunizations," since Ohio wasn't quite able to do it yet; same basically for syndromic surveillance. One is on the list, so that if I personally diagnose Ebola or plague in my office, I could send something to the state, if the state were able to receive it, which it isn't.

Moving right along, thinking the worst was behind me, I was homing in on October, November, and December 2014 as my 90-day, make-or-break period.

The EHR periodically filled in a dashboard of measures, so I could see how I was doing. I was doing fine with stuff like diabetic management, blood pressure control, BMI assessment, flu, and pneumovax administration, but, some weird stuff was in there. I had to have received a certain percentage of diagnostic image results as an image rather than a report from the radiologist. I don't have a picture archiving and communication system set up between my hospital and practice and it is not forthcoming. I could count EKGs and Holter monitors, even bone densities, since they appear as image-type documents. So I'm scrambling around to look for every bone mineral density image and EKG I can find.

I ran the dashboard in mid-December 2014, and discover I am failing to meet two core measures: prescription eligibility verification and patient access of electronic care summaries. I spent several weekends, going back and verifying every patient's prescription eligibility, forgetting that every e-prescription I refilled from a telephone call was not being checked. It turns out that there is a batch function that the former secretary does to check the eligibility of all the patients being seen that day. The new secretary didn't know about it, and neither did I.

So I sent e-mails to all of my Web-enabled portal patients asking them to download a patient care summary. We routinely give each patient a summary of the visit as they leave, so they really didn't need another summary.

I ran the dashboard for the last time in January 2015, covering the fateful last 90 days of 2014. Nope, not enough diagnostic images, not enough patients clicked on getting an electronic summary, and not enough prescription eligibility checks.

Done and gone.

Do I even want to think about wasting more time on this stupidity, for $4,000? But now they're talking about penalties. Yikes.