This obstacle to effective clinical decision support for the diagnostic process is underscored by the failure of our certification criteria to support usability, efficiency and E/M compliance. Only six of the Certification Commission for Healthcare Information Technology's more than 330 criteria consider the history and physical at all; five of these are not robust, and one presents data-entry tools that the ONC and HHS in a 2007 white paper on Enhancing Data Quality in EHRs have identified as having the ability to "open the EHR-S up to fraud or abuse."
Further, in the 1,092 pages of new criteria related to meaningful use there is only one sentence that even mentions the existence of the clinical history, with no discussion of how it should be designed or used to promote usability, compliance and/or quality diagnostic care. It is not possible to meaningfully drive a car that lacks an operable engine (even if it has a state-of-the-art global positioning system). The clinical history and physical is the central engine of the medical record.
We should be requiring meaningful use of meaningful EHRs certified by meaningful criteria. This means meeting physicians' requirements for systems that are operable as well as interoperable. That is, the history and physical component MUST fulfill physicians' standards for usability, efficiency, E/M compliance, data integrity and promoting the medical diagnostic process. Until we demand this, our software systems will interfere with, rather than promote, appropriate, accurate and timely diagnoses.
Stephen R. Levinson, M.D.
Owner, ASAEaston, Conn.