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Meaningful Use First Draft Could Guide Final Definition

John Commins, for HealthLeaders Media, June 17, 2009

The Health Information Technology Policy Committee stressed on Tuesday that the meaningful use definitions recommended by a study committee this week are merely a non-binding "first step" in a complex winnowing process. The final product could change a great deal when CMS issues a proposed rule change for a 60-day public comment period at the end of 2009.

However, David Blumenthal, MD, HHS' national coordinator for health information technology, did not dismiss the idea that components in Tuesday's first draft definition of meaningful use would remain in the final rules, which will be phased in from 2011 to 2015.

"It's going to be up to your readers to decide what they can read into the discussions that occurred today and what they can't," Blumenthal told HealthLeaders Media after Tuesday's three-hour meeting. "I suspect that as this discussion proceeds, certain themes will recur. I've certainly said publicly that we are very intent on using the meaningful use authority and the high-tech legislation to lay the ground work for improved health system performance."

"It's not going to be about technology to the maximum extent possible," Blumenthal says. "We are going to look for the effectiveness of systems in achieving healthcare change, rather than looking at the function and technical aspects of the system. The discussion today could only have reinforced that viewpoint, but that discussion is not binding, and the recommendations are not binding."

The recommendations discussed in the advisory committee meeting were drafted over the last month by the committee's meaningful use workgroup. "We had a lively discussion," Blumenthal says. "It was decided after considerable input on the topic of meaningful use that we would take the discussion back to work on it a little longer and bring back another set of recommendations to the health IT policy committee, which we will do in about a month."

The advisory committee meets again on July 16. "At that time, we will look at a revised set of recommendations on the definition of meaningful use," Blumenthal says. "If the committee can come to consensus on those definitions, it may be possible to produce recommendations within days or weeks thereafter. But I don't want to anticipate or predict exactly what the committee will decide to do."

President Barack Obama's recovery act provides about $19 billion in reimbursements through Medicare/Medicaid incentive payments to physicians and hospitals and other eligible providers that adopt "meaningful use" of EHR. The uncertainty of the definition has caused great angst and speculation because of scheduled reductions in Medicare reimbursements for providers, who don't meet the as-yet undefined "meaningful user" definition.

Jonathan Teich, MD, an assistant professor of medicine at Harvard Medical School, says Tuesday's first draft provides "a good sense of where things are going." "Some of the specifics may change, but if I were a CIO or a CMO, or a practicing quality leader, I think I would have a reasonable sense of what they are expecting," Teich says. "I know they are not expecting extreme outcome measures to happen in 2011. I do know also, though, that they expect me to be doing electronic ordering in that time. So, if I'm making purchases or setting up implementation timetables, this is a good start. We will see more changes over the next couple of months as things get refined and regulated, but I'd have a pretty good sense of what's going on now."

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