Meaningful Use and Missed Opportunities

I am writing this post, with the intent of writing a series of rants about the Meaningful Use objectives.

Let’s start with quality measures. I believe this is a huge missed opportunity because we will accomplish them using the same tired back-end abstracting approach we have always used. I believe the quality measures will fail to be a tool for caregivers to monitor safety and quality; nor will they create a means by which payers, government or consumers can compare quality.

All of the report specifications are written using SNOMED codes, and we do not use that medical nomenclature today. In fact, virtually nobody uses SNOMED. Why not write the quality measures using medical descriptions?

But the real kicker is that everyone is rushing to measure something without talking about the clinical processes and the appropriate place and way to capture the data in real-time. If we want to be able to have good comparisons, we need to have comparable clinical processes.

Each measure requires thousands of hours of work to design the right clinical workflow and IT processes. But instead of having objectives that define best practice for managing care and capturing data in real time, we jump straight to measurement. We skipped the most important step.

Simple example: eight of the 15 hospital EHR quality measures deal with stroke. At what point do we know that a patient is a stroke patient? Is it when a stroke nurse completes a stroke assessment? Is it when the radiologists reads the brain scan? Is it when the attending physician reviews the CT interpretation and makes the diagnosis and instructs the nurse to begin a plan of care?

Assuming one of these is correct, a hospital’s EHR would need:

• a codified stroke assessment form;
• the ability for the record representing the CT scan of the brain to be flagged by the radiologist (or rad tech) as indicating stroke; and/or
• the creation of a stroke plan of care.

There are NO meaningful Use objectives for any of this. Are hospitals using EHRs to monitor stroke in real-time and take corrective action when proper care is not given? Almost none. Instead, a human being will read the hand-written notes and dictated physician reports, then key ICD-9 codes into the EHR. Those will then be translated into SNOMED codes to populate reports.

Unfortunately, all of this will take place long after the patient has left the hospital.