Medicine
The ambitious federal effort to improve the quality of patient care in the U.S. by providing up to $30 billion in incentives to physicians who demonstrate "meaningful use" of certified electronic health records (EHRs) has now entered a new stage, aptly described in a recent Family Practice Management article as either a "second wave or a tsunami," depending on one's point of view. Officials at the Centers for Medicare and Medicaid Services believe that meaningful use will ultimately provide meaningful benefits to patients. However, this hypothesis has largely remained untested. In an editorial two years ago, I summed up the state of the science as follows: "the evidence is far from conclusive that EHRs and CDSSs [clinical decision support systems] improve preventive care processes and outcomes in primary care settings."
A research letter published last week in JAMA Internal Medicine examined the association of being a "meaningful user" with performance on 7 quality measures for hypertension, diabetes mellitus, coronary artery disease, asthma, and depression during a 90-day reporting period in the fall of 2012. 540 meaningful users were compared to 318 other outpatient physicians using the same EHR in Brigham and Women's Hospital-affiliated practices. Meaningful users performed slightly better in controlling cholesterol levels and blood pressure, worse in treating asthma and depression, and the same on the 3 remaining measures, compared to non-meaningful users.
Although these preliminary findings are unlikely to affect plans to move ahead with Stages 2 and 3 of meaningful use over the next few years, they remind family physicians of the real goals of practice transformation, and caution us not to conflate meeting meaningful use targets with making patients' lives longer or healthier.
**
This post first appeared on the AFP Community Blog.
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Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Two Types Of "scut Work"
When I was an acting Medicine intern in Manhattan's Bellevue Hospital at the turn of the century, all employees who provided the hospital's "ancillary services" went home between the hours of 5 PM and 8 AM. It was the job of the on-call interns...
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In a previous post, I summarized the mixed evidence that using electronic health records with clinical decision support systems (CDSSs) improves processes and outcomes of preventive care. Most of the literature supporting a positive effect of EHRs with...
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Several years ago, when I was a very junior faculty member at a well-regarded medical school, I was asked to give a lecture to first-year students about, among other things, medical licensure and specialty board certification. I considered this task to...
Medicine
Does Meaningful Use provide meaningful benefits to patients?
The ambitious federal effort to improve the quality of patient care in the U.S. by providing up to $30 billion in incentives to physicians who demonstrate "meaningful use" of certified electronic health records (EHRs) has now entered a new stage, aptly described in a recent Family Practice Management article as either a "second wave or a tsunami," depending on one's point of view. Officials at the Centers for Medicare and Medicaid Services believe that meaningful use will ultimately provide meaningful benefits to patients. However, this hypothesis has largely remained untested. In an editorial two years ago, I summed up the state of the science as follows: "the evidence is far from conclusive that EHRs and CDSSs [clinical decision support systems] improve preventive care processes and outcomes in primary care settings."
A research letter published last week in JAMA Internal Medicine examined the association of being a "meaningful user" with performance on 7 quality measures for hypertension, diabetes mellitus, coronary artery disease, asthma, and depression during a 90-day reporting period in the fall of 2012. 540 meaningful users were compared to 318 other outpatient physicians using the same EHR in Brigham and Women's Hospital-affiliated practices. Meaningful users performed slightly better in controlling cholesterol levels and blood pressure, worse in treating asthma and depression, and the same on the 3 remaining measures, compared to non-meaningful users.
Although these preliminary findings are unlikely to affect plans to move ahead with Stages 2 and 3 of meaningful use over the next few years, they remind family physicians of the real goals of practice transformation, and caution us not to conflate meeting meaningful use targets with making patients' lives longer or healthier.
**
This post first appeared on the AFP Community Blog.
- Two Types Of "scut Work"
When I was an acting Medicine intern in Manhattan's Bellevue Hospital at the turn of the century, all employees who provided the hospital's "ancillary services" went home between the hours of 5 PM and 8 AM. It was the job of the on-call interns...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Two Types Of "scut Work"
When I was an acting Medicine intern in Manhattan's Bellevue Hospital at the turn of the century, all employees who provided the hospital's "ancillary services" went home between the hours of 5 PM and 8 AM. It was the job of the on-call interns...
- Evidence That Ehrs Can Promote Better Preventive Care
In a previous post, I summarized the mixed evidence that using electronic health records with clinical decision support systems (CDSSs) improves processes and outcomes of preventive care. Most of the literature supporting a positive effect of EHRs with...
- Quality Assessment In Primary Care: An Imperfect Science
Several years ago, when I was a very junior faculty member at a well-regarded medical school, I was asked to give a lecture to first-year students about, among other things, medical licensure and specialty board certification. I considered this task to...