Meaningful Use: Method in the Madness?

I was on the road last week and on Tuesday came across an article in what is now a ubiquitous accessory in most of the hotels where I stay. USA Today is either in the lobby or right outside my door each morning. Who would have guessed a National newspaper would become so popular when it was launched 30 years ago? Of course, I would not have predicted the success a sports-only TV program would garner when it launched a few years before, but I digress. The front-page article that caught my eye last Tuesday featured the 2012 America Health Rankings. The not so flattering message was that Americans are living longer but not healthier lives.

 

Although life expectancy crept up to 78.5 years, the percentage of Americans who are obese and sedentary continues to climb. Rates of diabetes and heart disease are rising as well. The United Health Foundation assimilates this information and displays it on their interactive web site. The web site provides a break down by state and ranks each state by aggregating a number of healthcare related parameters. Vermont leads the way again, claiming the top spot for the 4^th consecutive year. Mississippi and Louisiana bring up the rear, tied for 49^th place on the list. One of the paradoxes in all of this is that as a nation we substantially outspend every other industrialized country in the world, now devoting almost 18 percent of GDP to healthcare, but our outcomes on the national stage are not very flattering.

 

MU to the Rescue?

 

Many in the nephrology community lament the meaningful use framework was constructed with primary care in mind. In fact one could argue the program was launched with little concern for the practice of nephrology. The dilemma presented by the intersection our dialysis patients and the meaningful use program is perhaps the best example of this line of thought. The fact that less than 1 percent of the physicians in the U.S. are nephrologists likely has something to do with this oversight.

 

From a population-health perspective however, one could easily argue the meaningful-use focus is exactly where it should be. Among the 64 Stage 2 clinical quality measures (CQMs) providers may choose to report to CMS are eight that deal exclusively with diabetes.  In addition there are 25 CQMs that focus on preventive health care.

 

Why are we required to capture demographics like race and ethnicity? In large part because there are significant health disparities among different demographic and socioeconomic groups. Why are we compelled to capture height and weight to demonstrate meaningful use? Take a look at the BMI scale below. Find your height on the left and look at the red zone on the right.

 

 

Over one third of the US population is now in the red zone with a BMI exceeding 30. Notice the orange sector in this table. There are typically 30 to 40 pounds separating healthy weights from obesity. Is it any wonder we are compelled to measure BMI and generate care plans as part of meaningful use?

 

And finally there is tobacco use. Smoking rates are trending downward in this country, but tobacco use remains the leading cause of preventable death in the United States. One in five adults smokes cigarettes today. By compelling us to inquire about smoking, the meaningful use framework creates another avenue to wrestle this public health issue to the ground.

 

The meaningful use program has taken a lot of heat. EHR vendors are compelled to devote substantial resources to meaningful use certification, sometimes at the expense of focusing on usability. Providers often find it more time consuming to interact with technology than with a paper-based record system. A large part of the challenge is change management. The Stage 1 objectives will at times seem like barriers of little importance. I would suggest thinking of the Stage 1 objectives as baby steps towards a greater goal. Stage 1 is providing fluency with the fundamental components of the electronic health record. Stage 2 will raise the bar by adding robust clinical decision support and true interoperability. In a couple of years we will be preparing for Stage 3. If all goes as planned, the Stage 3 objectives will bring us closer to moving the needle towards improved healthcare outcomes. A painful process for sure, but Shakespearean plays aside, there is almost certainly method in the madness.