A Clinical Perspective on MU3

Last week, Centers for Medicare & Medicaid Services (CMS) published the long-awaited final rule for Stage 3 of Meaningful Use (MU), along with modifications to Stage 2 of the program. Although the call of many stakeholders, including the American Medical Association, for delay of Stage 3 was not answered, the final rule does make Stage 3 optional in 2017, and shortens the reporting period during which providers must maintain compliance with MU to avoid penalties.

Despite these allowances, many clinicians are still concerned that MU3 will not have much positive impact on patient care, especially relative to the amount of effort required to achieve its compliance. Amidst all the activity surrounding MU, it’s important to remember that MU impacts many people who don’t have much of a voice in the process, i.e. clinicians. We check in here with Dr. John Stevenson, a physician on the front lines, who is affected by the sequelae of MU on a daily basis.

Dr. Stevenson, a nephrologist for nearly 40 years,  has run several small private practices in California and Texas. Dr. Stevenson's MU-compliant medical group is ahead of the curve with respect to MU, as less than half of hospitals and only about 10% of physicians have attested to MU2.  Now faced with implementing MU3 for his clinics, he shared with us some of his thoughts on the program:

Secure messaging: MU3 requires that various percentages of patients access their electronic health record (EHR) through an Application Program Interface (API), receive clinically-relevant correspondence through secure messaging, and incorporate patient-generated data (from a non-clinical setting) into their EHR.

While Dr. Stevenson believes that patient access to lab reports and other summary information will be a good thing, he is concerned with the potential consequences of patient use of secure messaging. For example, he says, "if a patient sends a message on Friday night which needs urgent attention, but won't be seen until Monday, it could lead to a bad outcome."

In addition, he notes that his practice is having difficulty getting enough patients to use the new technology, though he is confident they will succeed eventually. "It's not a perfectly level playing field," he says, "as I have a very old patient population, of whom quite a few still do not use computers or email."

Patient-generated data: Patient-generated data could generate considerable amounts of non-billable, unreimbursed work for clinicians. Dr. Stevenson says, "if a patient sends me a list of home blood pressures, in order to respond appropriately I will need to review the patient's chart, medication list, etc.  If I am really going to make it a worthwhile communication, it will require significant time and effort on my part." He shares the opinion of many clinicians that there should be a system for reimbursing this type of work, which will be significantly increased by the provisions of MU3.

E-prescribing: MU3 requires physicians to send 80% of prescriptions to pharmacies electronically, but some pharmacies do not employ reciprocal technologies. Curiously, pharmacies are not required by MU3 to comply with e-prescribing, even though physicians are required to send prescriptions this way.

Although the potential efficiencies made possible by EHRs are great, Dr. Stevenson states that "the huge problem is lack of interface between different systems," and that the solution is "a set of national standard formats for electronic health information, just like the internet has html standards, so that all EHRs could interface with each other, and also with laboratories, clinics, and all the various entities which produce medical data."

While Dr. Stevenson shares a common opinion that MU has not achieved the goal of improved patient care, he remains optimistic about the capability of technology to do so. He says, "Overall, very honestly, now that we are a fair way into meaningful use, I am pretty skeptical that it has produced or will produce much improvement in patient care.  My feeling about electronic medical records overall is very different, however.  The promise of EMR is only at the very beginning."