Electronic Medical Records Meaningful Use

Today is Saturday on my weekend off. I have not posted in a few days. The business has been busy. I am going to do a couple of work related tasks this weekend.  This will probably take all weekend. My son wants to go to a movie, so if I can get ahead on these things than maybe I can go later. I have to go through  all of my patients lab results and either call people or leave a Secure Reach message for them. I have to call some people back for messages that they left for me, when I couldn't get through to them yet. Then the hospital paper charts need to be finished and signed off on. That will take at least a few hours. We all have to do that once every week or two if we want to maintain our hospital staff privileges. This particular job has recently become a new Electronic Medical Record. So the change from old paper charts to new electronic ones is underway, and the learning process is going to be steep and another time consuming job.

In the business of the business I recently underwent a voluntary audit for "electronic medical record meaningful use". It turns out that the US Federal Government has decided that getting physicians off of paper charting and onto computers is a goal worth funding and pushing. To that end, the legislature has funded bonuses for physicians who have and use an Electronic Medical Record. But, not any medical record will do. For instance, just scanning in paper notes and keeping an electronic copy is not meaningful use. Although it is very tempting because it is a super easy way to make the transition. And then new notes can be written in, for instance, Microsoft Word. This all can be done. But it is not nearly good enough to survive an audit and get the bonus. We need to use certified software, which we of course have. And we need to create digitally accessible data. Over the years, the amount and quality of that data needs to improve.

In my audit, we discovered that the Feds want to see, for instance, smoking data. The old smoking codes were, smoking, nonsmoking, how much in the past, etc. But the Feds want highly standardized data, so the codes going forward will change to their requirements. All of the docs and the differening EMR softwares had their own unique codes, habits, shorthand, and words for this data. It used to be good data if there was any data on that point at all. In the past, when we would get audited for smoking data by whoever did that audit, they would look in the paper charts and see that it was written in, and we would get credit for doing that. Now, the Feds want it all in digital codes.

We also discovered that the Feds want highly standardized ethnic data. They want a data field that described  ethnicity, and they have only a few alternative words. There is only 7 or 8 options. So, we will have to try to categorize people. It will go into the demographics section of the chart. To be meaningful use, it has to be done.

But in my practice, in Northern New Jersey, 20 minutes from New York City, one of the world biggest genetic "melting pots" in existence, these categories are nonsense. How would you categorize someone that is African, grew up in Japan, and now lives in New York City? He may be culturally Japanese, genetically African, not much American in him yet, but yet I have to pick a category. And I have a number of South Africans in my practice. These people are Genetically Dutch, very white, have lived in the States for only a short time. But their genes have not seen Europe in centuries, and I have to pick their ethnicity. There is no code for White African. For that matter I have patients that are clearly Black African Americans, by heritage, custom, upbringing, dialect, and everything else, but they are whiter than me. And it is hard to get whiter than me. So, I have to categorize them as African Americans. They may be very wealthy as well. Clearly their ethnic code is not going to have the same meaning as a poor inner city kid who could never get an opportunity to succeed, and is therefore stuck in poverty. They should at least let me code for poverty. Middle Eastern doesn't have a code. Neither does subdividing Caucasian. There is a very big difference between Ashkenazi white, and Nordic, for instance. I don't see the value in these codes. Most people are mixes now anyway. Me and my wife are both mixes of several different ethnicities, including a bit of Native American but mostly West European. There is no code for mix, although I think there is an "other", which will have to be used a lot.

So, for meaninful use I will have to learn to use a few more data fields, and push a few buttons in my software differently. I will have push the button "reviewed allergies with patient", instead of the "done" button. I will have to add a specific code for "no meds" rather than leaving that section blank. And a few other things. It doesn't look so hard to actually do. It is just in the details.

Meaningful use also means that the software can create a specific kind of standardized database that holds all of the data, and that can be transmitted to any other software that is approved for meaningful use. This will be really great, and I fully support. It means data portability. And all of you techies out there know the value of that.

Once I get my meaningful use criteria up to good quality, I can get my bonus, if I otherwise qualify. As you can imagine the rule book is many pages long and very hard to read and understand.

I still owe you all a post on contraceptive methods, and various methods benefits and risks. I will get to that. After that, I think I will discuss VBAC, or vaginal birth after cesarean section.

Once again, thank all of you for reading this.

Google reports that the readership of this blog is continuing to grow, and readership is growing even though I haven't posted in a few days So I will keep writing it.

Sincerely,

John Marcus MD
Obstetrics and Gynecology
Ridgewood, New Jersey, USA

201-447-0077
member of The Lifeline Group at www.lma-llc.com, dedicated to giving the best medical care possible, with scientifically validated protocols, one patient at a time.