The road to meaningful use compliance is often difficult to navigate, and it does not get any easier for specialties...
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outside the primary care space. One example is obstetrics and gynecology (OB-GYN), where specialists must trudge through quality reporting measures, meaningful use attestation and electronic health record (EHR) tribulations all to gain a user-friendly experience.
Any advantage a clinician has in converting to an electronic workflow is a bonus. Georgia obstetrician Anne Patterson has a head start on many specialists in regards to meaningful use -- she is also an engineer who started her professional career working for NASA before earning her M.D. This, she said, helps her understand the gap between how non-clinical software engineers program and how physicians actually work.
Patterson is working toward meaningful use attestation at her small practice. That has been smooth sailing so far, partly because her experience gives her the ability to do some systems integration and customization work herself, and partly because of prior experience with EHR implementation at a 22-provider practice, which she later sold.
EHR use easier when systems make sense
Patterson worked with the EHR vendor on customizations that saved time in the workflow. This taught her lessons she could use when first adopting her current system and then tuning it up for her current practice, which she shares with one other obstetrician. "You want it to be user-friendly so that when you want to pull up previous data [on a patient], it's easy to get to."
User-friendly has found its way into the vernacular when describing EHR and electronic medical record (EMR) use. (Generally speaking, an EHR is capable of sharing data with other systems, while an EMR is not.)
Craig Strafford, M.D, a member of the American College of Obstetricians and Gynecologists (ACOG), an OB-GYN at Holzer Clinic (Ohio) and an indigent clinic, believes user-friendly EMR systems are more than a want: They are a need. "Systems must be carefully designed so the clinician can read accurate information," he said. "Patients rightfully object when you are looking at a computer and talking to them."
The need for a well-designed system is critical so providers can reap its benefits, clinically speaking. One of the benefits, Strafford said, is that EMR systems work on a "need to know basis." This provides rapid access to imaging, past medical history and medication information among other data. For example, memory aids such as popup reminders to avoid medication duplication in prenatal care hold a premium.
However, getting an EHR or EMR system to function properly is not always a reality. Systems have a tendency to collapse, Strafford said. When that happens, clinicians cannot do anything -- no viewing images or submitting lab orders -- and, as a result, the schedule gets delayed.
You want it to be user-friendly so that when you want to pull up previous data [on a patient], it's easy to get to.
Anne Patterson, M.D., obstetrician
Malfunctions such as interface issues could stem from software bugs or miscommunication with a vendor. "You want the system to work how the education tutorial said it would, [but] vendors often overpromise the system’s capabilities because they want to sell their product," Strafford said. That can frustrate providers. They are often not involved in the EHR selection process -- that task is generally handled by an administrative and IT team -- and as a result are unable to spot problems before EHR implementation happens.
OB-GYN meaningful use regulations focus on patient screenings
The aforementioned issues highlight the challenges of demonstrating meaningful use. That said, it does not change the fact that eligible providers, or EPs, are required to report on all core objectives, unless exclusions apply. Fortunately, for OB-GYNs, many do.
Additionally, EPs must report on six total clinical quality measures: three required core measures (substituting alternate core measures where necessary) and three additional measures from a list of 38.
Key reporting measures for OB-GYN include the following:
- Breast cancer screening
- Prenatal care: screening for Human Immunodeficiency Virus (HIV)
- Prenatal care: Anti-D immune globulin
- Cervical cancer screening
- Chlamydia screening
The challenges of meaningful use regulations stem from the fact that they have been designed by people who eventually want to reduce the nation's $2.5 trillion investment in health care.
For example, Strafford said that less frequent care is gaining traction since it omits unnecessary visits, like the case of breast cancer screening. “It is not every woman every year," he said. "Now we think that less frequent care is more appropriate."
To that end, Stafford said, the quality measures exist to make sure that OB-GYNs are providing the appropriate level of care required to treat patients.
Let us know what you think about the story; email Craig Byer, Assistant Editor.