HealthWorks Collective hosted this week’s Grand Rounds with ten great articles from around the healthcare/medical blog world. Be sure to check it out. I found this article from Dr. Pullen to be especially interesting. He writes about his experience so far this year in complying with the new regulations imposed by WA state law (pertaining to chronic pain and making sure that patients with ongoing pain medication are not in danger of (or already) abusing their pain meds) and Medicare guidelines (meaningful use for electronic medical records).
Reading about these regulations and paperwork requirements – from the perspective of a doctor who is complying with them – does make one wonder if perhaps there is a way to reach the same goals (in this case, patients who aren’t abusing pain meds, and EMRs that are widespread, efficient, cost-effective, and beneficial) without so much labor-intensive paperwork.
Dr. Pullen mentions that his office has been using electronic medical records since 1997 (!) They also have a “virtual disease management registry” to help them take care of patients with chronic illnesses, and they use printed prescriptions instead of hand written ones. Despite all of this very ahead-of-the-curve healthcare IT, his office still has to jump through the same hoops as everybody else in order to qualify for the Medicare incentives for EMR “meaningful use”.
Although Dr. Pullen’s office is obviously way out in front in terms of their use of information technology, there are plenty of medical offices that likely need the incentive from Medicare just to get going with EMRs in the first place. Whenever we take our boys in to our family practice doctor for their wellness checkups, I always notice the walls full of manila folders and wonder how much work it’s going to be to convert all of that to digital files. For practices that haven’t been using EMRs at all, maybe the meaningful use guidelines (and the related compliance tasks) will help to guide the practices in the right direction as they implement their healthcare IT. But for practices that have already been using digital technology for years, maybe we need different rules. Dr. Pullen’s article highlights the fact that compliance with meaningful use guidelines is taking away from his face time with his patients. And that definitely isn’t the goal.
Perhaps there could be some leeway in the guidelines to allow practices that already have well-established healthcare IT to demonstrate their own “meaningful use”. I’m sure there would be more initial work for the people who are in charge of overseeing compliance, but would it be worth it in terms of increasing (or at least, not decreasing) the amount of time that doctors get to spend with their patients rather than completing forms?
The compliance guidelines that Dr. Pullen details with regards to pain management are state specific, but again, it sounds like an onerous process. He notes that the goal of regulating pain treatment to prevent abuse is “…right on target, but the details of the regulations is onerous.”
I don’t know what the solution is here. On the one hand, we need regulation. We know that without it, there are way too many cracks into which all sorts of things can fall. And regulation is meaningless without having a way to objectively measure compliance and progress. But when we reach the point where doctors feel that they’re spending more of their time doing clerical work (eg, filling out compliance paperwork, documenting everything for their lawyers and for their patients’ health insurance carriers, etc.) than interacting with patients, perhaps it’s time to re-evaluate.
This is especially important as the ACA rolls out over the next few years. One of the goals is to make healthcare more efficient. But if we inadvertently end up bogging down the healthcare professionals in a sea of red tape and bureaucracy, efficiency is likely to decline. Hopefully doctors and nurses and other healthcare professionals – who work in the healthcare field on a daily basis – can be consulted to provide input on how best to measure compliance with well-intentioned regulatory programs.