Federal meaningful use requirements are well intentioned, but like a teacher who "teaches to the test," the federal meaningful use program created a very complicated system that might pass the test of meaningful use stages, but is not producing meaningful results for patients and clinicians.

As reported on April 14, 2014 in MedScape a formal study published in the April 2014 issue of JAMA Internal Medicine shows no correlation between quality of care and meaningful use adherence. This study validates what common sense has told many of us for the last few years.

Meaningful use Stage 1 was a jump-start for EMR adoption in the industry. That's a good thing, I suppose, although meaningful use also created a false market for mediocre products. It's time to put an end to the federal meaningful use program, eliminate the costly administrative overhead of meaningful use, remove the government subsidies that also create perverse incentives and let "survival of the fittest" play a bigger part in the process. Let the fruits of EMR utilization go to the organizations that commit, on their own and without government incentives, to maximizing the value of their EMR investments toward quality improvement, cost reduction and clinical efficiency.

When I arrived at Northwestern Medicine in 2005, it was clear very early that our EMRs (Epic and Cerner) were not being used in a meaningful way; this was several years before any broad discussion of meaningful use in the industry. Many Northwestern physicians were still using paper charts alongside the EMR, thus creating a fragmented and dangerous medical record for patients.

Using the log and audit files in Epic and Cerner, we created an "EMR Utilization Dashboard" for each physician that also rolled up to the organizational level. The data was revealing. Outside of General Internal Medicine and a few other spotty areas, the medication list was not being used. The problem list was not being used. Order entry (CPOE) for medications, prescriptions, and tests was not being used. Templates for documentation efficiency were not being used. Clinical alerts for best practices were not being used. Many patient encounters were not being documented in the EMR, indicating the continued use of paper records. In short, these very expensive EMRs were being used only occasionally as expensive word processors and dictation systems.

With input from all physicians, Drs. David Liebovitz, Phil Roemer, Gary Martin, and I decided to develop a simple document, describing the core principles of EMR utilization. Sarah Miller, the director of clinical applications, also played a huge part in this project. We declared that it had to be constrained to a single page, normal spacing and font, and that we had to be data driven. It was a big success. Over the next two years, our rudimentary EMR Utilization Dashboard showed steady and significant improvement.