NOSH ChartingSystem

A new open source health charting system for doctors.


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Meaningful Use Stage 3 and Three Quarters

It is with regret that Meaningful Use legislation has barreled down the path of insanity.  As a primary care physician, I don’t see how 700+ pages of rules and proposals mean any bit of relevance to my clinical practice anymore.  As the attrition continues regarding eligible providers, it is leading primary care physicians towards the junction point of going off the grid entirely or being enslaved by horrible EHR’s forever.

I won’t bother giving a point-by-point critique of Meaningful Use Stage 3.  If you want to know the details, there are some well written posts by Dr. Hamlaka and Margalit Gur-Arie, if you want to amuse yourself, beseech the gods, or cry (I have experienced all three).

Instead, in this post, I’d like you to close your eyes and imagine being a physician-wizard-to-be, stepping on a train platform called Meaningful Use and walking towards Stage 3…all the while looking for a Stage 3 and three-quarters written on a piece of paper in your hand.

On the Stage 3 platform, you come across a gate that has a sign that lists the 10 commandments by Dr. Octo Barnett, written way back in 1970:

1. Thou shall know what you want to do
2. Thou shall construct modular systems – given chaotic nature of hospitals
3. Thou shall build a computer system that can evolve in a graceful fashion
4. Thou shall build a system that allows easy and rapid programming development and modification
5. Thou shall build a system that has consistently rapid response time and is easy for the non-computernik to use
6. Thou shall have duplicate hardware systems
7. Thou shall build and implement your system in a joint effort with real users in a real situation with real problems
8. Thou shall be concerned with realities of the cost and projected benefit of the computer system
9. Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization
10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.

Pondering at the sign, you can’t help but be annoyed by a parrot overhead cackling “Keep it simple, stupid!” over and over again.  Looking down, you see what you thought were train tracks, but is actually a cobblestone path.

Curious, you open the gate and climb off the platform.  You start walking down the rocky cobblestone path for a mile or so, when you stumble into a deep, dark forest.  You then come to a murky lake and pages and pages of what appears to be Meaningful Use legislation are found floating in the lake.  As you reach down to pick up one of the pages, a spindly hand grabs hold of your arm, pulling you face down into the lake.

Immediately, you feel like you’re suffocating from the murky water, unable to see what is pulling you deeper and deeper.  You continue to struggle, but it’s no use.  As your feet finally touch the bottom depths of the lake, the spindly hand lets go of your arm and you find yourself immersed in darkness and shadows.

You begin to see shapes of what appears to other physicians, ambling aimlessly in the dark water.  They are staring at computer screens like zombies, unable to look away to focus on you.  They mumble incomprehensible words but you can feel their anger, fear, and frustration in the way their muscles twitch on their face, uncontrollably.  You can sense they’ve been imprisoned in the lake for years and years.  They have forgotten how to heal.

Looking up, you somehow see all the pages still floating above you, and yet all the light never shines through around it.  Puzzled, you turn all around to see where there could have been a light that allowed you to see the pages.  You look down into the muddy bottom and you see a small sparkle of luminescence.  Shuffling your feet to push away some of the ground beneath you, the light gets brighter.  You shuffle more dirt away with your legs, but the weight of the water wears you out.  Fatigued, you drop down onto the barren lake bottom.  You try to keep your eyes open, staring at the light, hoping to never lose sight of it.  In desperation, you pound your fist into the dirt.  Suddenly, the dirt gives way and you fall into a blindingly bright cave chamber.   A torrent of water rushes all around you as you fall in, knocking you headlong into a rocky wall.  You pass out.

As you come to, you awake to find yourself in a brightly colored room.  Next to you is another physician holding a tablet.  The physician looks intently at you as you come to and asks how you’re feeling.  Before speaking, you notice that there is a serene calmness in the room.  Despite the presence of the tablet, the physician appears to be highly focused on you instead.  You notice that the physician is minimally entering information into the system either through voice recognition or performing 1 to 2 taps at most for any search query.  The physician rarely has to take his eyes off you during the interview and subsequent examination.  You peer over the physician, looking at the tablet.  You see a screen that appears to be very simple, clean, and uncluttered in its appearance.  The physician actually looks happy and smiles at you.  You ask where you are, and he responds, “You, my friend, are in my clinic for a head injury.  What you’re experiencing is Meaningful Use Stage 3 and three-quarters.”

“What does that mean?”

“It means, simply, that you’re seeing a physician being happy with using the latest technology tools in harmony with practicing medicine and treating their patients.  It can be done, but we must never forget that the ones using the tools ought to be the ones who design and refine the tool.  These tools are meaningless and harmful if we don’t know how to harness it and sculpt it to our needs.  To prevent that, we must never cede our needs and our knowledge to someone else who doesn’t really know what physicians do.  Technology engagement and keeping a constant eye on patient safety and improving patient care ultimately leads to real meaningful use.  It’s not rocket science.  It’s a very simple concept that adheres to Dr. Barnett’s 10 commandments and doesn’t require 700 pages to decipher it.”

“So, what do I do now?”

“Once you’ve recovered, go forth on your quest to be a great physician.  And when you see other physician-wizards-to-be as well as physician-zombies, tell them to look for Meaningful Use Stage 3 and three-quarters.  They will learn soon enough that Meaningful Use Stage 3 is an illusion, an unnecessary distraction, and a path towards destruction for all that is sacred in medicine.  The right path is the one not so easily seen, but is simple in all respects.”