Meaningful use began as an initiative to use electronic health record’s throughout United States to improve quality, safety and efficiency of healthcare delivery and decrease health disparities. It was further intended to help engage patients in their healthcare and improve health care coordination.
Meaningful use initiatives include but are not limited to computerized order entry, electronic prescription prescribing, provider patients the ability to view online the health information, incorporate clinical lab tests and use of secure electronic messaging.
From a physician’s perspective, this has resulted in more use but less meeting. In the framework of meaningful use, the physician is treated as a secretary. He or she gets interrupted countless times throughout the day to enter orders that in the past were taken care of within the framework of good quality patient care by ward secretaries. Often the physician is attempting to provide high quality care such as patient or family education or attempting to work out a complex medical problem and they are interrupted to perform some menial task such as releasing an order for a straight cane for homegoing. These multiple interruptions add up to multiple hours in an average day. Each interruption results in logging back on the computer which takes multiple steps as a computer is never allowed to be left on when not attended.
On the rehabilitation unit, these meaningful use requirements including physician order entry are particularly disruptive. At the heart of Rehabilitation Medicine is a team concept. Although the Rehabilitation Physician is designated the team leader, Rehabilitation Medicine is a very collegial atmosphere in which all the team members from therapy, nutrition, nursing and allied health are all respected for their valuable input. They all have individual rolls and are empowered following our team discussions to act.
An analogy of the current situation would be a plant manager that had hundreds of employees reporting to him with tasks that needed to be done. These employees would report to the manager what needed to be done and the manager himself would have to perform the tasks while all of his employees waited for him to complete them. This is the situation that arises in the Hospital as a physician is bombarded with multiple request from multiple different disciplines to complete tasks that historically they would do themselves. They are simply the ones most qualified to properly complete these tasks.
Unfortunately, many of the meaningful use requirements, including physician order entry risk decreasing quality of patient care. The physician can get lost in the weeds and have all their time taken from high quality interactions.
Over time, hopefully the pendulum will swing back and we will achieve a better balance of physician time expectations, allowing him or her to truly have high-quality interactions with patients and their families