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  1. Rod Baird
    Jan 14 - 3:52 pm

    Our practice has employed a CCHIT EMR since 2000. We have our own IT department, and write custom interfaces for our providers. We do eRx, PQRI, and securely distribute encrypted clinical notes to other provider locations.

    Inspite of that experience and level of capability, we have a set of continuing, unresloved, problems with achieving meaningful use. They are specific to the locations where our providers (35 in number) practice – Nursing Homes(75 in number). These facilities have the statutory responsibility for procuring all patient services (e.g. prescription meds, labs, etc.).

    Our providers interact with these facilities 24×7, but are only on site a few hours to several days a week. Many orders are given via telephone from the side of the road, or from the bed during the middle of the night.

    Very few of the facilities have open internet connections, and many are in remote locations or have heavy concrete construction which makes it difficult/impossible to procure a decent cell phone signal, much less an wireless internet connection.

    Even a reatively simple exercise like eRx is fraught with complexity. No nursing facility is equiped to receive/sent eRx orders, so creating a scheme where our providers could demonstrate compliant behavior required an arrangement of Rube Goldberg complexity. Even then, when we tried to perform eRx in 2010, it failed at many locations. Why? Because the largest LTC pharmacy and the Surescripts Hub do not talk to each other (we assume this based on fees).

    We understand from the clinical staff at some of the larger EHR vendors that the ONC is aware of these issues – but there is no documentation of the steps we could take to ‘work around’ the Meaningful Use criteria until CMS sets standards for LTC facilities and the pharmacies that serve them.

    We assume our problems should be of significant concern to CMS- the population we serve in nearly 100% Medicare/Medicaid, a significant portion are near the end of life and are in the top quarter of expenses per beneficiary.

    Unfortunately, we have raised this and similar questions with CMS over the past year with NO response.

    Happy New Year

    • A Cavale
      Jan 22 - 7:41 pm

      Excellent points. We have been electronic since 2002 as a solo practice. Of course CCHIT only came into being in 2007, so we have been certified since then. I totally agree with your issues. Surescripts having monopoly with e-Rx has been a huge problem ever since I began interacting with them in 2008. Besides, the MU criteria are simply one-size-fits-all, which is what we could expect from a government mandate! If ONC truly wants “meaningful use” of IT, let the consumers/patients and their physicians/hospitals decide that constitutes meaningful use for them. In my opinion, all this noise is an exercise in futility. We probably already satisfy most criteria, but I will choose not to sign up because I simply don’t agree with the premise that some govt agency can decide what is meaningful use. We have had enough non-clinicians deciding about “medically necessary” criteria; we don’t need another govt agency telling how to use IT.

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