Chistopher M. Notte, MD

By the time you read this, you will be aware of the recent changes in the "meaningful use" timeline announced on Dec. 6, 2013. For those who may have missed it, the Centers for Medicare and Medicaid Services, in conjunction with the Office of the National Coordinator for Health Information Technology, proposed a delay in the meaningful use roll-out in response to mounting concern over the viability of the program deadlines. Essentially, this amounts to an extension of stage 2 through 2016, a hold on initiation of stage 3 criteria until 2017, and a delay in penalties for noncompliance until 2015. In response to the announcement, many physicians are breathing sighs of relief. This additional amnesty promises to ease some concerns, as well as allow for an examination of how far the MU program has come, and where it will be going in the future.

We routinely receive messages from readers outlining their concerns over the practicality of the meaningful use incentive program. We have continued to publish these comments as we feel there is tremendous benefit in giving voice to fellow doctors who are frustrated with EHR technology. We are hopeful that the thoughts expressed in this and other forums are at least partly responsible for the delay announced last week, as the concerns are real and practical. One recent message, which brings criticism (both for EHRs and for us), comes from Dr. Michael Lavery, an internist in Manchester, N.H. Dr. Lavery tells of his own experience with an EHR, which he fails to find "meaningful." He writes:

"Other than the obvious benefits of not needing scribes and paper charts, EHRs have not delivered on their promise of increased efficiency. In our large primary care practice, we are now EHR veterans, having adopted an electronic record several years ago. Since then, we have not had occasion to use the data contained therein for ‘improving population health’ or improving access to care, as those in the government would like. On the contrary, the EHR has only increased the amount of work we all have on a daily basis. I, for one, find myself continuously entering data that may or may not be easy to retrieve and can only hope for improvement in my typing skills. I am bothered when I read your column and see that you are extolling the benefits of Health IT without pointing out the shortcomings. Then, when you do speak of the challenges, you imply they are only due to a poor choice of systems or a fault of the individual physician’s unwillingness to accept the new technology. I resent this. I have always been a champion for change and completely embrace new technology when it becomes available. In the case of EHRs, however, the technology has not delivered on the promise, and our jobs are harder as a result. My experience has not been one of improved patient care, but of diminished physician lifestyle ... "

Dr. Lavery expressed a common reaction to the current state of health information technology, and EHR vendors and the government are taking notice. The change in the meaningful use implementation timeline is an indication of this acknowledgment. Industry experts have observed that the additional time is a great relief to EHR companies, which are struggling to make their products stage-2 compliant. Beyond mere compliance, we are hopeful that the extra time will also lead to improved usability of EHR systems and enhancements that are truly "meaningful" to physicians and patients. This could come in the form of improved clinical decision support, more efficient documentation, or better population management tools. We think vendors are starting to get the message and believe EHR software is maturing to adopt these ideas.

We are also optimistic as we look ahead to the stage 3 criteria. Several influential organizations – including the American Medical Association, the American Academy of Family Physicians, and others – have strongly encouraged the CMS to design the stage 3 criteria around improving patient care and physician efficiency, instead of simply demonstrating data collection capabilities. While this has been the goal of stage 3 all along, the growing pains experienced in implementing the first two stages have given reason for pause; efforts to finalize the official criteria have been put on hold until the first half of 2015. It is the intent of the CMS and the Office of the National Coordinator for Health Information Technology to carefully consider all of the feedback they receive before coming to a conclusion on the measures.

In his comments above, Dr. Lavery took issue – not only with the message – but also with the messengers. He identified columnists like us as cheerleaders for substandard technology who blame the user instead of the EHR software’s lack of usability. In response, we want to assert our fundamental belief that EHR technology only improves care delivery when it complements the "art" of medicine. We feel though that it is important to understand that these early stages of EHR adoption represent a transition point. Just as any child of the 21st century would laugh at the rudimentary nature of a 20th-century video game system, we will all likely one day reflect on this generation of EHRs with incredulity and condescension. One hopes we will also understand this era as the foundation of a new type of medicine – medicine that attends to the needs of – and values – physicians, patients, and populations through high-quality care and "meaningful" technology.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps.

By the time you read this, you will be aware of the recent changes in the "meaningful use" timeline announced on Dec. 6, 2013. For those who may have missed it, the Centers for Medicare and Medicaid Services, in conjunction with the Office of the National Coordinator for Health Information Technology, proposed a delay in the meaningful use roll-out in response to mounting concern over the viability of the program deadlines. Essentially, this amounts to an extension of stage 2 through 2016, a hold on initiation of stage 3 criteria until 2017, and a delay in penalties for noncompliance until 2015. In response to the announcement, many physicians are breathing sighs of relief. This additional amnesty promises to ease some concerns, as well as allow for an examination of how far the MU program has come, and where it will be going in the future.

We routinely receive messages from readers outlining their concerns over the practicality of the meaningful use incentive program. We have continued to publish these comments as we feel there is tremendous benefit in giving voice to fellow doctors who are frustrated with EHR technology. We are hopeful that the thoughts expressed in this and other forums are at least partly responsible for the delay announced last week, as the concerns are real and practical. One recent message, which brings criticism (both for EHRs and for us), comes from Dr. Michael Lavery, an internist in Manchester, N.H. Dr. Lavery tells of his own experience with an EHR, which he fails to find "meaningful." He writes:

"Other than the obvious benefits of not needing scribes and paper charts, EHRs have not delivered on their promise of increased efficiency. In our large primary care practice, we are now EHR veterans, having adopted an electronic record several years ago. Since then, we have not had occasion to use the data contained therein for ‘improving population health’ or improving access to care, as those in the government would like. On the contrary, the EHR has only increased the amount of work we all have on a daily basis. I, for one, find myself continuously entering data that may or may not be easy to retrieve and can only hope for improvement in my typing skills. I am bothered when I read your column and see that you are extolling the benefits of Health IT without pointing out the shortcomings. Then, when you do speak of the challenges, you imply they are only due to a poor choice of systems or a fault of the individual physician’s unwillingness to accept the new technology. I resent this. I have always been a champion for change and completely embrace new technology when it becomes available. In the case of EHRs, however, the technology has not delivered on the promise, and our jobs are harder as a result. My experience has not been one of improved patient care, but of diminished physician lifestyle ... "

Dr. Lavery expressed a common reaction to the current state of health information technology, and EHR vendors and the government are taking notice. The change in the meaningful use implementation timeline is an indication of this acknowledgment. Industry experts have observed that the additional time is a great relief to EHR companies, which are struggling to make their products stage-2 compliant. Beyond mere compliance, we are hopeful that the extra time will also lead to improved usability of EHR systems and enhancements that are truly "meaningful" to physicians and patients. This could come in the form of improved clinical decision support, more efficient documentation, or better population management tools. We think vendors are starting to get the message and believe EHR software is maturing to adopt these ideas.

We are also optimistic as we look ahead to the stage 3 criteria. Several influential organizations – including the American Medical Association, the American Academy of Family Physicians, and others – have strongly encouraged the CMS to design the stage 3 criteria around improving patient care and physician efficiency, instead of simply demonstrating data collection capabilities. While this has been the goal of stage 3 all along, the growing pains experienced in implementing the first two stages have given reason for pause; efforts to finalize the official criteria have been put on hold until the first half of 2015. It is the intent of the CMS and the Office of the National Coordinator for Health Information Technology to carefully consider all of the feedback they receive before coming to a conclusion on the measures.

In his comments above, Dr. Lavery took issue – not only with the message – but also with the messengers. He identified columnists like us as cheerleaders for substandard technology who blame the user instead of the EHR software’s lack of usability. In response, we want to assert our fundamental belief that EHR technology only improves care delivery when it complements the "art" of medicine. We feel though that it is important to understand that these early stages of EHR adoption represent a transition point. Just as any child of the 21st century would laugh at the rudimentary nature of a 20th-century video game system, we will all likely one day reflect on this generation of EHRs with incredulity and condescension. One hopes we will also understand this era as the foundation of a new type of medicine – medicine that attends to the needs of – and values – physicians, patients, and populations through high-quality care and "meaningful" technology.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps.

By the time you read this, you will be aware of the recent changes in the "meaningful use" timeline announced on Dec. 6, 2013. For those who may have missed it, the Centers for Medicare and Medicaid Services, in conjunction with the Office of the National Coordinator for Health Information Technology, proposed a delay in the meaningful use roll-out in response to mounting concern over the viability of the program deadlines. Essentially, this amounts to an extension of stage 2 through 2016, a hold on initiation of stage 3 criteria until 2017, and a delay in penalties for noncompliance until 2015. In response to the announcement, many physicians are breathing sighs of relief. This additional amnesty promises to ease some concerns, as well as allow for an examination of how far the MU program has come, and where it will be going in the future.

We routinely receive messages from readers outlining their concerns over the practicality of the meaningful use incentive program. We have continued to publish these comments as we feel there is tremendous benefit in giving voice to fellow doctors who are frustrated with EHR technology. We are hopeful that the thoughts expressed in this and other forums are at least partly responsible for the delay announced last week, as the concerns are real and practical. One recent message, which brings criticism (both for EHRs and for us), comes from Dr. Michael Lavery, an internist in Manchester, N.H. Dr. Lavery tells of his own experience with an EHR, which he fails to find "meaningful." He writes:

"Other than the obvious benefits of not needing scribes and paper charts, EHRs have not delivered on their promise of increased efficiency. In our large primary care practice, we are now EHR veterans, having adopted an electronic record several years ago. Since then, we have not had occasion to use the data contained therein for ‘improving population health’ or improving access to care, as those in the government would like. On the contrary, the EHR has only increased the amount of work we all have on a daily basis. I, for one, find myself continuously entering data that may or may not be easy to retrieve and can only hope for improvement in my typing skills. I am bothered when I read your column and see that you are extolling the benefits of Health IT without pointing out the shortcomings. Then, when you do speak of the challenges, you imply they are only due to a poor choice of systems or a fault of the individual physician’s unwillingness to accept the new technology. I resent this. I have always been a champion for change and completely embrace new technology when it becomes available. In the case of EHRs, however, the technology has not delivered on the promise, and our jobs are harder as a result. My experience has not been one of improved patient care, but of diminished physician lifestyle ... "

Dr. Lavery expressed a common reaction to the current state of health information technology, and EHR vendors and the government are taking notice. The change in the meaningful use implementation timeline is an indication of this acknowledgment. Industry experts have observed that the additional time is a great relief to EHR companies, which are struggling to make their products stage-2 compliant. Beyond mere compliance, we are hopeful that the extra time will also lead to improved usability of EHR systems and enhancements that are truly "meaningful" to physicians and patients. This could come in the form of improved clinical decision support, more efficient documentation, or better population management tools. We think vendors are starting to get the message and believe EHR software is maturing to adopt these ideas.

We are also optimistic as we look ahead to the stage 3 criteria. Several influential organizations – including the American Medical Association, the American Academy of Family Physicians, and others – have strongly encouraged the CMS to design the stage 3 criteria around improving patient care and physician efficiency, instead of simply demonstrating data collection capabilities. While this has been the goal of stage 3 all along, the growing pains experienced in implementing the first two stages have given reason for pause; efforts to finalize the official criteria have been put on hold until the first half of 2015. It is the intent of the CMS and the Office of the National Coordinator for Health Information Technology to carefully consider all of the feedback they receive before coming to a conclusion on the measures.

In his comments above, Dr. Lavery took issue – not only with the message – but also with the messengers. He identified columnists like us as cheerleaders for substandard technology who blame the user instead of the EHR software’s lack of usability. In response, we want to assert our fundamental belief that EHR technology only improves care delivery when it complements the "art" of medicine. We feel though that it is important to understand that these early stages of EHR adoption represent a transition point. Just as any child of the 21st century would laugh at the rudimentary nature of a 20th-century video game system, we will all likely one day reflect on this generation of EHRs with incredulity and condescension. One hopes we will also understand this era as the foundation of a new type of medicine – medicine that attends to the needs of – and values – physicians, patients, and populations through high-quality care and "meaningful" technology.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is also a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. An avid programmer, he has published software for handheld devices in partnership with national organizations, and he is always looking for new ways to bring evidence-based medicine to the point of care. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates mobile apps.