Monday, March 9, 2015

Should There Be a Continuous Medical Education Mandate for Computerized Order Entry and Meaningful Use?

MA Physicians Must Show EHR Proficiency; the State of Massachusetts now has licensure requirements the include proficiency in the user of the Electronic Health Record (EHR).  These include understanding computerized order entry (CPOE), meaningful use, and the core EHR. 

In Florida, there are core continuous medical education (CME) requirements: HIV, medical errors (risk management) and domestic violence.  Clearly, every time a new "hot problem" arises, a new CME requirement is generated.  Next will be Ebola and vaccinations (measles, flu,?).

It is not necessarily bad to make sure that everyone is up to speed on certain topics, but what topics should be selected?  A case can be made for multiple topics both general and specialty specific.

The issue with adding the EHR under the general CME umbrella is a lack of industry standards.  Knowing how to use an EHR at a specific location does not necessarily translate into competence with other EHR applications.  Workflow is characteristically site-specific, so users ma approach the software quite differently.  You would not deal with an automated CPOE interface the same at a 120,000 visit ED as you would at a 14,000 visit ED. CPOE varies from vendor to vendor as well as the workflow for using CPOE from site to site.

 It is often essential to understand the result of a right click on the mouse  on any system. How about when going from system to system?  Will you get rodent dyslexia?  Maybe!?!  For more on the right click, read my prior blog on the Right Click Dilemma!  It is noteworthy that recruitment ads for locum tenens already include the type of system in place at the practice or hospital seeking physicians.

The second piece of the puzzle is understanding meaningful use.  Understanding meaningful use?  Seriously!?!  Remember that MU is the government's attempt to promote adoption of EHRs.  It does not, and should not, directly affect patient care.  Attention to it by practices and hospitals is ordinarily to make sure they get their share of the incentive money.  Physicians are being told, "please check these boxes, so we can be paid", but unless a physician is seeking to become an informatics subspecialist, does he or she really need to know what MU is about?

The ultimate solution is establishing national standards for the operation of any EHR, including CPOE as well as patient databases.  If every system used the same fundamental database and CPOE, the provider can figure out the various approaches used by vendors.  Remember, the Massachusetts medical society backed this issue.  HL7 has been working on it for years, and has many tools to enable EHR standardization.  Why not adopt realistic standards?  That would certainly be a meaningful, and useful thing to do.

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