The End of Meaningful Use: A Meaningful Opportunity

The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt said Monday that 2016 would likely see the end of the meaningful use program. Meaningful use is a carrot-and-stick government program designed to get medical providers to use electronic health records (EHRs) and to set standards for using them. The carrot: medical providers who show compliance with meaningful use regulations get incentive payments from the government. The stick: those who do not are assessed financial penalties (257,000 received penalties in 2015).

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The latest Mayo Clinic study on physician burnout shows that in 2014, 54.4% of physicians admitted to at least one symptom of burnout. This is up from 45.5% in 2011. In the non-physician population, the number is about 25%.

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Why the burnout? Lots of reasons, but a major one is that many doctors are spending a lot of time doing things that are not just peripheral to what we went into medicine for, but inimical to it.

When I decided to go into medicine almost thirty years ago, I wanted to do work that didn’t involve sitting in front of a computer all day. My father was a computer systems analyst, and while he brought home cool stuff from the office, I wanted to work with people. So I chose medicine. And somewhere along the way, something changed.

Like many doctors, over the years I found myself spending more and more of my patient care time staring into a computer screen. This in and of itself might not have been so bad, except that it was time taken away from the time I used to spend looking at my patients: looking them in the eye, observing the subtleties of their body language, watching how they breathe or fidget or tremor. And increasingly, the time in the computer was spent doing things that satisfied “Meaningful use” standards, but in no meaningful way improved the care I was providing to the person in the room; in fact, it detracted from care by taking the finite resource of the time I spend with patients and wasting it on irrelevancies. Instead of serving patients, doctoring began to feel like serving the machine, responding to its needs in preference to the needs of patients. Unsurprisingly, a lot of doctors feel this way.

Serving machines instead of people: a good recipe for burnout. The CMS may finally be figuring that out.

Meaningful use was based in part on the blind faith that technology is good, so more must be better. That’s why, in Andy Slavitt’s words, it “reward[ed] doctors for the use of technology.” Think about that: a program that rewards doctors not for improving patient care, or fostering better patient-physician relationships, or making contributions to medicine, but for . . . using technology. Might as well pay us for using smart phones.

Current EHRs have been designed (from all appearances, without knowledge of what physicians actually do in the office) to facilitate increased billing  and to meet meaningful use. Getting rid of meaningful use is an opportunity to completely redesign EHRs — using what physicians actually do as a guide — to make them a useful adjunct to the practice of medicine, rather than a burnout-promoting waster of colossal amounts of time; to enhance (or, at the very least, not detract from) the patient-physician relationship; and to put the patient rather than the technology back at the center of what physicians do.

This may require hefty changes, the complete rethinking and redesigning (maybe scrapping) of current EHR systems. This could be disruptive; but sometimes, when you make a mistake, the best thing to do it to go back and erase it and start over. And if change resulted in doctors getting back to being doctors, I think most of us would welcome it. As Slavitt said on Monday, “We have to get the hearts and minds of physicians back. I think we’ve lost them.” Using this opportunity to completely rethink and overhaul EHR systems is a good way to see that happen.

 

 

 

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