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The Meaning of Meaningful Use

Carrie Vaughan and John Commins, for HealthLeaders Magazine, June 11, 2009
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What does the term mean, and what will it mean for the healthcare industry? Healthcare IT experts consider the features, functions, and favorability factors.

Meaningful use: Two words that have caused consternation, confusion, and carping in the healthcare industry. Until the Obama administration defines what "meaningful use" of electronic health records means, there will be speculation and anxiety among physicians and hospital executives.

To have full access to the approximately $19 billion in net reimbursements for EHRs earmarked in the American Recovery and Reinvestment Act, hospitals must meet the as-yet undefined meaningful user criteria by Oct. 1, 2010, while the similarly undefined physician meaningful user criteria takes effect on Jan. 1, 2011.

With little data to go on, but with billions of dollars potentially at stake, the industry is stumbling forward using only the content-challenged guidelines provided by ARRA. Those guidelines set three major markers for EHR: electronic prescribing, data exchange outside the walls of the organization, and quality measurements.

How ambitious should the goals be?
The promise of EHR interoperability will mean that some day physicians will instantly access a massive electronic medical library to identify an evidence-based course of treatment for a particular patient with a particular set of symptoms or illnesses. Until that day of promise arrives, however, some EHR advocates say meaningful use should concentrate on more pedestrian goals.

Steve Art, senior vice president and CIO for Lutheran HealthCare, a 401-staffed-bed Brooklyn, NY-based health system, says meaningful use should be based on how many people use the EHR system and how well adopted it is, not on what features and functions it has. When a physician orders a medication, Art says, the EHR should ensure that it goes straight to the pharmacy where it is verified and sent directly to the nursing staff, which then administers the order to the patient.

"All of these other things—sharing records and interoperability—are great to have in the future, but we all need a way to get a physician to write an order so the patient gets the right drug at the right time of day at the right place in their body," Art says. "We need a system that helps us not order 45 lab tests."

While federal EHR guidelines would be useful, Art says providers don't need standards that are too specific because each provider knows what it needs and can make the best choices on their own if they aren't overburdened with government regulations. "Hospitals are big enough to understand what is good for us feature- and functionwise and what isn't good for us," Art says. "The question is, at what point do I need to have the software that I buy regulated?"

James R. Morrow, MD, a CCHIT Commissioner and medical director of professional services with Chicago-based technology vendor Allscripts, says meaningful use EHR should effectively track patient data and manage that data for the betterment of the patient. It should include physician order entry and internal system alerts to warn physicians about problems and interactions with the orders like clinical decision support. Meaningful use should also facilitate the import/export of medical reports and lab results. "One of the biggest drawbacks in the paper world is that physicians don't know anything about their patients as a group," says Morrow, who is the former vice president and CIO of North Fulton Family Medicine in suburban Atlanta.

Catherine Bruno, the CIO of Brewer, ME-based Eastern Maine Healthcare, a seven-hospital system, says the federal government could save everyone a lot of trouble and stress if it phased in meaningful use. "My sense . . . is that you either have 'meaningful use' or you don't. If you qualify, you get the money and if you don't, you don't," Bruno says. "Don't have it be all or nothing. There should be different phases so a small hospital could have help getting some funding as they work toward getting a more sophisticated health records over time."

What will meaningful use include?
The stimulus package language says an EHR system should have the capacity to provide clinical decision support, support physician order entry, capture and query information relative to healthcare quality, and have interoperability.

Using that information, Bruno says providers may need to be at a minimum of stage four on the HIMSS Analytics maturity model for EHRs to be eligible for the stimulus incentives from Medicare. "Some are saying you have to be all the way to stage six," says Bruno, explaining that stage four includes CPOE and stage six includes full physician documentation and a closed-loop medication administration system. Bruno says the long-term goal of the government is to improve patient safety and reduce costs. "To meet those goals, you are going to have access to data beyond your own health system," she says.

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