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The Meaning of “Meaningful” From the Physician Point of View
By Keith Belton

The healthcare industry and those who follow it got a first look at what the HIT Policy Committee considers to be “meaningful use” of an EHR on June 16. Anticipation over the committee’s definition of meaningful use has been high because beginning in 2011, physicians and hospitals can receive incentive payments under Medicare and Medicaid for their use of an EHR but only if that use is considered meaningful.

With so much predefinition speculation, Nuance Communications decided to ask a large sample—more than 15,000 of our physician customers—what meaningful use means to them. Not only did we seek to learn what physicians considered essential components of the definition, we wanted to get their views on how, if at all, speech recognition plays a part in physicians achieving true meaningful EHR use.

We set out to explore and measure physicians’ opinions of the value of EHRs from a variety of perspectives, including ease of adoption, key capabilities, and the impact on productivity and patient care, as well as overall cost/benefit analysis. We asked questions about ease of use, cost hurdles, perceived return on investment, patient safety, clinical note detail, security, and integration. We also asked for their opinion on the American Recovery and Reinvestment Act, as well as their opinion of initiatives to digitize all patients’ records by 2014.

Among the findings are the following:

EHRs slow down physicians. Ninety-three percent “disagree” or “strongly disagree” that using an EHR has reduced time spent documenting care (outside of work and at work). Not surprisingly, 67% of the doctors surveyed cited “time associated with reliance on keyboard and mouse to document within an EHR” as a major hurdle.

EHRs are “dumbing down” the quality of patient documentation. Seventy-four percent of the doctors surveyed said “EHR cookie cutter templates” and “patient notes with no uniqueness” are challenges to realizing the full value of EHRs. The implication? Purchasing expensive EHRs alone, without providing physicians tools to personalize patient notes, may actually contribute to lower quality patient documentation.

Improved quality, accessibility, and more instant availability of clinical information should be considered as potential determinants of meaningful use, as digitizing information alone is not enough. When asked about qualifications that the federal government should measure as part of payouts associated with EHR meaningful use, physicians cited the following:

• Ninety percent said “access to medical records faster without waiting for records to come out of transcription” was “important” or “very important.”

• Eighty-three percent said “more complete patient reports, with higher levels or detail on the patient’s condition and visit” was “important” or “very important.”

• Eighty-three percent said “better caregiver-to-caregiver communication based on improved reporting that is more accessible and easily shareable” was “important” or “very important.”
• Seventy-nine percent said “improved documentation by pairing the EHR point-and-click template with physician narrative” was “important” or “very important.”

Providing tools enabling physicians to personalize each record are among the most highly valued capabilities. When asked about the importance of various EHR components, physicians identified the following as the five most important:

• lab test results reporting and review;

• documentation tools that allow doctors to speak the physician narrative into the EHR;

• e-prescribing;

• secure health messaging between caregivers; and

• keyboard support via speech recognition for data entry into the EHR.

Ninety-three percent of doctors surveyed either “agree” or “strongly agree” with the following statement: “I think capturing physician narrative as part of the documentation process is necessary for complete and quality patient notes.”

Seventy-five percent surveyed said they consider “access to tools that would help doctors to better document within an EHR (beyond the keyboard), such as speech recognition” an incentive, whereas 69% cited “stimulus money.”

The results of this survey taught us that physicians value readily available, highly detailed EMRs as the most merited for government reimbursement. The study also shows that physicians have concerns surrounding existing obstacles to EHR adoption: usability, cost, learning curves of a new system, increased time documenting care, and the inability to use dictation to create medical notes. Moreover, three quarters of physicians believe enabling technologies to document care in the EHR—with speech recognition clearly a major member of potential solutions—should be included under the definition of meaningful use.

— Keith Belton is senior director of product marketing for Nuance Communications.