We’ve been hearing so much lately about Meaningful Use and its incentive payments to physicians (up to $44,000 and $64,000 from Medicare and Medicaid, respectively) for implementing an electronic health record (EHR) and meeting certain criteria. But what about the quality of care and the patient’s role in it? In a recap of a session at the 2011 HIMSS meeting, as reported in the on-line American Medical News, physician-patient visit time increased by 10 minutes as physicians are documenting more about their patients – specifically more metrics. Speaking of metrics, one study noted that, for patients with diabetes, reporting hemoglobin A1c values increased from 42% to 91% when an EHR was implemented. Another study reported that when patients are given access to their EHR via a secure portal, they tend to become more involved in their own health care.
This information is certainly encouraging, but we still face the daunting issue of interoperability. The www.amednews.com article notes that chronically ill elderly patients see an average of 14 different physicians. If this information is not easily exchanged between physicians and their offices, the patient may be forced into the role of historian, which is often problematic. Fortunately, efforts towards achieving interoperability are in high gear as health information exchange becomes a significant priority.
What does this mean for RDs and DTRs? Hopefully as physicians spend more time reviewing and recording metrics, those that are nutrition-related will be among these. Stage I of Meaningful Use is a good starting place: All eligible providers will be required to report on “Adult Weight Screening and Follow Up”—in order to receive their incentive payments. An alternate measure—“Weight Assessment and Counseling for Children and Adolescents” can be used if the provider sees pediatric patients. Referrals for nutrition intervention may increase as related data – or even alerts originated by the RD – display in front of the physician. And, as patients take charge of their own health care, especially with the increased emphasis on nutrition from changes such as mandatory menu nutrition labeling, they may themselves request a referral to an RD. In order to optimize participation from our profession, we need to be proactive in integrating nutrition at the appropriate levels.