Meaningful use criteria frustrating, but inescapable

Miami Beach, Fla. - Despite the initial inconvenience, a well-implemented electronic health record (EHR) system can improve patient care and office workflows, according to an expert.

Personally, says Doris Day, M.D., “I don’t find meaningful use to be very meaningful. I find it to be aggravating and time-consuming and sometimes a flat-out waste of time I could be using for continuing education, teaching or otherwise honing my skills. I find that many things that I end up having to document are unnecessary and not relevant for a dermatology practice.”

For example, she says that documenting each patient’s smoking history “may be meaningful and useful in a larger way, but not all the elements one must document are necessarily meaningful in a dermatology practice.” Dr. Day, who spoke recently at the South Beach Symposium, is clinical associate professor of dermatology at NYU Langone Medical Center, New York.

Good legislative intentions aside, Dr. Day says that meeting meaningful use requirements often detracts from patient care because physicians and their staff spend more and more time on administrative issues than interacting with patients.

“I understand that it has to be done, but you can’t legislate common sense. There’s a level of frustration with it, but I’m happy that I’m ahead of the curve,” Dr. Day says.

Going paperless early

Dr. Day’s practice has been paperless for nearly 15 years.

“Being in New York City, where we’re space-challenged, we ran out of room for charts very quickly. I even ran out of room for staff to file and pull charts. So for me, the switch to a paperless system, both for managing patient notes and documentation and for billing and scheduling, made sense early on,” she says.

She selected her current EHR package (Criterions Medical Suite, Criterions) 13 years ago.

“As the law has evolved and as requirements and regulations for certificates, Health Insurance Portability and Accountability Act (HIPAA) rules and other elements have come in, I’ve been working with the provider to make sure that we’re up to date, and that all the fields I need to document are searchable within the program. There’s a bit of work to it,” but she has found the vendor exceedingly receptive to providing support in these areas.

Now, “I can search for different headers or elements that I need to monitor or document,” Dr. Day says. “Instead of having people pore through chart after chart, I can pull it up relatively quickly and easily and feel confident that what I’m submitting is actually what I can prove I have done.”

Faster information access

Additionally, she says her system helps improve patient care.

“You can find information about patients more quickly, and share it with other healthcare providers much more easily - in legible English. You end up being able to spend more time with patient care and coordination rather than documenting, transcribing and figuring out your notes,” she says.

Dr. Day’s EHR system also allows patients to enter their demographic data, pharmacy information, allergies and the reason for their visit online before they arrive.

“When they come in, it makes check-in much easier. And when I see them, depending on the reason for their visit, I have a list of things I want to make sure I ask them. Everything is certified, properly encrypted and meets all the HIPAA requirements and standards,” she says.

At the end of the visit, the system enables Dr. Day to prescribe medications electronically if required, and to print or email patients their treatment plans. In the latter area, she adds, the EHR system allows her to communicate many more specific details for each individual patient - such as specialized aftercare instructions for photodynamic therapy or any other treatment - than anxious patients may be able to comprehend in the office.

To remind patients of their next visit, “We can text, email or call them. All of that requires minimal staff effort. That means I can have more efficient staff that makes more eye contact with patients rather than looking down at a piece of paper.”

Regarding EHR implementation, Dr. Day says, “If it has to be done, figure out a way to do it that will add value to what you do and detract as little as possible from your day. That’s what I’ve done. I’ve managed to make the most of it in terms of organization. I don’t believe that was exactly the point of it, but I’ve found a way to make it useful for me.”

In evaluating products and vendors, Dr. Day says no package is perfect - they all require adjustment to suit a dermatology practice. Practices also must adjust.

“When you’re used to charts and papers, that initial transition can be quite complicated and expensive,” she says.

But since making the switch, she says, “My life is so much better overall because I have my system set up the way I like it. I cannot imagine going back to pen and paper. I consider my EHR system to be my least expensive employee; it always shows up for work and is always on time.”

Disclosures: Dr. Day reports no relevant financial interests.