With very little fanfare, and certainly no apology, CMS recently canceled the Meaningful Use program. This program was designed to give medical practices cash incentives for not just adopting electronic health records, but for also using them up to their potential, not just as expensive word processors. I happen to believe that EHR’s are very helpful in maintaining good patient records, but the MU program was a classic example of bureaucratic overreach, which alienated many physicians and set back the cause of promoting EHR’s by several years.
The first mistake of MU was that it assumed that all patients need a very detailed medical record. Most people don’t. A small percentage of the population requires a lot of medical care, and for them the effort of creating and maintaining a meticulous chart up to MU standards is well-spent. We’re talking 5-10% of patients. For the rest of them, a much less elaborate way of record keeping does an adequate job of taking care of their medical needs. Medicare, for example, estimates that half of its beneficiaries use only 3% of its money in any given year. This disproportionate need for medical care is probably even more true for the population at large. Many people go years without needing a dollar’s worth of medical care. Clearly, people who use medical care so little need only simple charts to keep track of their occasional use of the health care system.
Patients who make infrequent visits to the doctor have simple needs: they just want a single problem fixed, be it a sore throat or a sprained ankle. MU asked that all sorts of information be collected from these patients when they came in for a visit, including family history, their vaccination record, and the date of their last Pap smear. This had to seem arduous and time-consuming at best, and kind of creepy at worst. No wonder there has been such a growth in the number of visits at emergency rooms and urgent care centers. Those venues take care of the problem at hand, and don’t waste time asking questions that are none of their business.
The fact that keeping MU-compliant records makes population-wide health management easier may have been a bug, not a feature. Doctors aren’t trained or paid, at least not much, to care for a population. Their obligation is only to the patient in front of them. And if the doctors care little about the health of the population, the patients care even less. To the extent they realize that health bureaucrats have access to their records, for the benefit of the “population,” they probably find this alarming. Patients go to the doctor for the benefit of themselves and their families, not for the public good, and these visits are intensely private. I don’t think that, even with assurances of anonymity, that patients are eager to share them.
Meaningful Use was the product of healthcare “experts” that fundamentally misunderstand the intimate nature of medical care. It should start with building trust between two people, a patient and a clinician, and the system should be kept unobtrusively in the background. Patients deserve medical care, not medical management. That is meaningful.