When the stage 2 final rule for meaningful use was released, the healthcare industry expressed generally positive feedback. However, a few organizations, such as the American Hospital Association, expressed some discontent with the rule and its requirements — provisions like the timeline for attestation sparked some concern. Healthcare professionals and associations representing hospital interests have been vocal about their opinions of meaningful use. The question is: How do physicians feel?
According to Brian Zimmerman, MD, a physician in the emergency department of Miami Valley Hospital in Dayton, Ohio and a physician champion for electronic health record deployment for the parent company of Miami Valley Hospital, Premier Health Partners, a large health system serving southwest Ohio, the general reaction among the physician world has been frustration. Physicians are increasingly dismayed by meaningful use because the requirements are complicated, they slow work flows and the value is not always overt.
Despite benefits, physicians are becoming frustrated
While physicians have seen some benefits from stage 1 of meaningful use, such as increased efficiency for entering order sets and better access to notes on patient records, the progression toward meaningful use has not been entirely easy.
"We want to do what's best for the patients, but there are an increasing number of hoops we have to jump through. It is making providers increasingly frustrated. I understand there is a good reason for the guidelines — to protect the patient and ensure high-quality care," says Dr. Zimmerman. "At the same time, the increasing number of hoops we have to jump through to get reimbursements, meet meaningful use and justify the cost of these EHRs is becoming frustrating," he adds.
Challenges
Here are two major areas that Dr. Zimmerman feels are challenging for physicians.
1. Patient engagement requirements. The requirements in stage 2 that push for patient engagement are concerning to physicians. For instance, providers will be required to provide patients with a summary of care within a certain amount of time. Five percent of patients will have to "view online, download and transmit" the care record in order for the provider to meet the requirement. Another requirement calls for providers to offer secure messaging to patients. According to Dr. Zimmerman, these requirements have raised some eyebrows in the physician world.
"Physicians and nurses are going to have to get mechanisms in place so they can ensure patients will do [this]. That is really bizarre. Patient compliance is always a difficult thing. Every provider understands that," says Dr. Zimmerman. "To link [the stage 2 requirements] to what patients are doing at home is somewhat over the top. It is one thing for providers to recommend what patients do at home, but to say that five percent of the patients have to do it? That is tough," he adds.
2. Lack of control. Physicians do not have a great deal of control over meeting meaningful use, which is frustrating to them. According to Dr. Zimmerman, many physicians feel that hospitals are getting the most benefit from meaningful use, at least financially, while their workflows are compromised, potentially hurting their compensation.
"[Physicians] feel they are being forced to add new processes to their workday because the hospital wants the incentives. If physicians cannot see the benefits, they may have difficulty accepting meaningful use," says Dr. Zimmermann. "When [physicians] see fewer patients each day, which decreases their compensation, it becomes difficult to have a positive viewpoint," he adds.
What can hospitals do?
Physicians are very important for a hospital's road to meaningful use. For this reason, hospital executives need to be cognizant of their struggles and concerns. Here, Dr. Zimmerman recommends four tactics that may help assuage physicians' potential problems with meaningful use requirements.
1. Transparency. In order to combat physician discontent and frustration with the pursuit of meaningful use, hospitals should be more transparent and open with goals and outcomes. When physicians are presented with evidence detailing the benefit to patients and themselves, they may be more likely to accept the challenges. "In the emergency department, we conduct time studies that show the palpable benefits of meaningful use — how it helps us move patients through the ED faster. If hospitals can provide all physicians with that type of data, it will show them that the challenge is worthwhile," says Dr. Zimmerman.
2. Choose a strong EMR. Although it may be intuitive, it is critical to note the importance of choosing a strong electronic medical record system. "This is a basic recommendation, but hospitals need to be on board with a good EMR. Some EMRs have built in functionality to make the stage 2 requirements easier. By and large, most of the EMRs are incorporating the requirements, so look for an EMR vendor that is putting forth effort and money for development of the EMR to make the process easier for physicians," says Dr. Zimmerman.
3. Streamline physician training. One of the pain points of meaningful use is training on the EMR, says Dr. Zimmerman. If hospitals can focus EMR training on provider workflows to emphasize benefits, improve functionality and improve the user experience, physicians will be happier with the process and the EMR in general. "We had 16 hours of EMR training before our initial go-live. Providers really do not like that. It is really tough. Of the 16 hours, only 3 to 4 were essential. Ongoing EMR training must be focused and efficient," says Dr. Zimmerman.
4. Adopt technology. Hospitals should look to technologies that not only support dictation into the EHR, but also allow for more complete documentation of the patient encounter. "At my organization, we've implemented Dragon Medical 360 | Network Edition to improve documentation. With a speech-enabled EHR workflow physicians can dictate the full patient narrative in their own words as opposed to notes built by point-and-click EHR templates alone," says Dr. Zimmerman. He believes this will become increasingly important, especially now that stage 2 is requiring electronic notes in the EHR. "Dragon also allows the providers to voice activate some of their common workflows and can speed up some of the common repetitive processes. This has become a huge physician satisfier at our organization," says Dr. Zimmerman.
With the release of the final stage 2 requirements, there is no turning back for providers or hospitals. Hospital executives hoping to receive the financial incentives from meaningful use should take note of the barriers their physicians face, so they may be addressed and eradicated.
CMS Releases Tipsheets on Meaningful Use Stage 2 Payment Adjustments
Stage 2 Meaningful Use Rule Receives Positive Feedback, But AHA Shares Concerns
According to Brian Zimmerman, MD, a physician in the emergency department of Miami Valley Hospital in Dayton, Ohio and a physician champion for electronic health record deployment for the parent company of Miami Valley Hospital, Premier Health Partners, a large health system serving southwest Ohio, the general reaction among the physician world has been frustration. Physicians are increasingly dismayed by meaningful use because the requirements are complicated, they slow work flows and the value is not always overt.
Despite benefits, physicians are becoming frustrated
While physicians have seen some benefits from stage 1 of meaningful use, such as increased efficiency for entering order sets and better access to notes on patient records, the progression toward meaningful use has not been entirely easy.
"We want to do what's best for the patients, but there are an increasing number of hoops we have to jump through. It is making providers increasingly frustrated. I understand there is a good reason for the guidelines — to protect the patient and ensure high-quality care," says Dr. Zimmerman. "At the same time, the increasing number of hoops we have to jump through to get reimbursements, meet meaningful use and justify the cost of these EHRs is becoming frustrating," he adds.
Challenges
Here are two major areas that Dr. Zimmerman feels are challenging for physicians.
1. Patient engagement requirements. The requirements in stage 2 that push for patient engagement are concerning to physicians. For instance, providers will be required to provide patients with a summary of care within a certain amount of time. Five percent of patients will have to "view online, download and transmit" the care record in order for the provider to meet the requirement. Another requirement calls for providers to offer secure messaging to patients. According to Dr. Zimmerman, these requirements have raised some eyebrows in the physician world.
"Physicians and nurses are going to have to get mechanisms in place so they can ensure patients will do [this]. That is really bizarre. Patient compliance is always a difficult thing. Every provider understands that," says Dr. Zimmerman. "To link [the stage 2 requirements] to what patients are doing at home is somewhat over the top. It is one thing for providers to recommend what patients do at home, but to say that five percent of the patients have to do it? That is tough," he adds.
2. Lack of control. Physicians do not have a great deal of control over meeting meaningful use, which is frustrating to them. According to Dr. Zimmerman, many physicians feel that hospitals are getting the most benefit from meaningful use, at least financially, while their workflows are compromised, potentially hurting their compensation.
"[Physicians] feel they are being forced to add new processes to their workday because the hospital wants the incentives. If physicians cannot see the benefits, they may have difficulty accepting meaningful use," says Dr. Zimmermann. "When [physicians] see fewer patients each day, which decreases their compensation, it becomes difficult to have a positive viewpoint," he adds.
What can hospitals do?
Physicians are very important for a hospital's road to meaningful use. For this reason, hospital executives need to be cognizant of their struggles and concerns. Here, Dr. Zimmerman recommends four tactics that may help assuage physicians' potential problems with meaningful use requirements.
1. Transparency. In order to combat physician discontent and frustration with the pursuit of meaningful use, hospitals should be more transparent and open with goals and outcomes. When physicians are presented with evidence detailing the benefit to patients and themselves, they may be more likely to accept the challenges. "In the emergency department, we conduct time studies that show the palpable benefits of meaningful use — how it helps us move patients through the ED faster. If hospitals can provide all physicians with that type of data, it will show them that the challenge is worthwhile," says Dr. Zimmerman.
2. Choose a strong EMR. Although it may be intuitive, it is critical to note the importance of choosing a strong electronic medical record system. "This is a basic recommendation, but hospitals need to be on board with a good EMR. Some EMRs have built in functionality to make the stage 2 requirements easier. By and large, most of the EMRs are incorporating the requirements, so look for an EMR vendor that is putting forth effort and money for development of the EMR to make the process easier for physicians," says Dr. Zimmerman.
3. Streamline physician training. One of the pain points of meaningful use is training on the EMR, says Dr. Zimmerman. If hospitals can focus EMR training on provider workflows to emphasize benefits, improve functionality and improve the user experience, physicians will be happier with the process and the EMR in general. "We had 16 hours of EMR training before our initial go-live. Providers really do not like that. It is really tough. Of the 16 hours, only 3 to 4 were essential. Ongoing EMR training must be focused and efficient," says Dr. Zimmerman.
4. Adopt technology. Hospitals should look to technologies that not only support dictation into the EHR, but also allow for more complete documentation of the patient encounter. "At my organization, we've implemented Dragon Medical 360 | Network Edition to improve documentation. With a speech-enabled EHR workflow physicians can dictate the full patient narrative in their own words as opposed to notes built by point-and-click EHR templates alone," says Dr. Zimmerman. He believes this will become increasingly important, especially now that stage 2 is requiring electronic notes in the EHR. "Dragon also allows the providers to voice activate some of their common workflows and can speed up some of the common repetitive processes. This has become a huge physician satisfier at our organization," says Dr. Zimmerman.
With the release of the final stage 2 requirements, there is no turning back for providers or hospitals. Hospital executives hoping to receive the financial incentives from meaningful use should take note of the barriers their physicians face, so they may be addressed and eradicated.
More Articles on Meaningful Use Stage 2:
The Road to Stage 2 Meaningful Use: Q&A With CMS' Office of E-Health Standards & Services Director Elizabeth HollandCMS Releases Tipsheets on Meaningful Use Stage 2 Payment Adjustments
Stage 2 Meaningful Use Rule Receives Positive Feedback, But AHA Shares Concerns