How Meaningful is Meaningful Use Part II

Recently I asked “How meaningful is meaningful use?”

Here’s my answer…not very. 

That’s not an entirely fair answer, or at least the tone implied isn’t entirely fair.  Meaningful Use makes EHRs more helpful than they were before, but only kinda sorta.  Mostly EHRs still disappoint because they fall far short of what they could (and should do). 

Here’s an example of meaningful use that I think is typical and illustrative:

I have a friend who is hypothyroid.  My friend is fanatical about his health.  Never misses medications, never misses a blood draw, and never misses a doctor’s appointment.  He got a letter from his health care system the other day extolling the virtues of regular check ups, the importance of monitoring thyroid levels, and how important diet and exercise were.  This letter was, no doubt, auto generated based on the EHR’s documentation that he is hypothyroid.  Elsewhere in that same record was his 100% attendance record for all appointments, his stellar trend of lab results, and even the fact that his BMI is normal and he has two-hour workouts 4-5 times a week.  The letter went a long way toward meeting meaningful use, but for him, it was anything but meaningful.  In fact, the opposite is true –it had no meaning for him personally except that his health care system knows almost nothing about him and eschews a one-size-fits-all mentality.  “The next time I get one of these I probably won’t even open it up,” he told me as he tossed it into recycling (this is Portland, after all).  There was nothing Meaningful about this letter.

Here’s what should happen…

When it’s time for him to get his thyroid function tests checked, an email reminder shows up with a link to schedule the test.  That’s it.  Behind the scenes, clinical decision support and analytics determine if the lab values are normal or abnormal, compare them to previous values to determine if there is a concerning trend (even if the absolute values are OK), and only bother him with a follow up email if there is a problem.  The normal BMI listed in the chart?  The normal vital signs at his last follow up appointment?  A normal cholesterol screen?  Diet and exercise?  You don’t need a reminder to do things that you’re already doing.  How about this instead?  My friend has an app that lets him log personal health facts into the health system’s EHR.  He’s feeling fatigued.  Or he wakes up at night feeling flushed.  Palpitations once in a while.  Sounds like a trend.  Now the EHR sends him a letter and it probably won’t end up in recycling.

The proposed Stage 3 Meaningful Use would encourage this paradigm, but I’m betting Meaningful stops at the patient entering data.  I bet it still relies on the provider noticing the data, analyzing the data, and acting on the data.  Well every provider I know already has too much data and no time to look at it.  And providers shouldn’t have to.  The EHR should be able to analyze the data, look for trends, and recommend interventions and it should do this automatically, in the background.

THAT sounds meaningful.

And we can do that.  That’s what we do.