The Health IT Policy Committee approved revised recommendations for defining "meaningful use" of electronic health records this past Thursday. But for many providers—especially rural community hospitals and solo or small group practices—the objectives for meaningful use are still out of reach.
The bar needs to push providers, while ensuring that a reasonable number of leading-edge organizations can achieve it by 2011, says John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a Bellevue, WA-based seven-hospital system with a 500-member medical group. Haughom is no stranger to HIT. Roughly 14 years ago, PeaceHealth implemented a community health record that shares patient information with providers throughout the region—including its competitors. The community health record has roughly 2 million patient records in its database and more than 20,000 clinical users—only a portion of whom are PeaceHealth employees.
The HIT Policy committee's recommendations are "pretty close" to where they need to be, says Haughom. But he's concerned that the current recommendations "will discourage organizations that aren't as far along" in the process of implementing EHRs. The three objectives of the ‘meaningful use' recommendations that he says should be scaled back are:
CPOE. The recommendations call for 10% of all orders of any type to be directly entered by an authorized provider through CPOE by 2011. Haughom wants that bar lowered even further. "I'd cut it in half down to 5%," he says. "That means organizations that are reasonably close–even if they haven't implemented CPOE—could launch pilots and have a chance of hitting it," he says. Haughom would prefer the timeline for CPOE to be something like 5% in 2011, 10% or 15% in 2012, and so on.
Electronic problem list. Providers and hospitals must maintain an up-to-date problem list of current and active diagnoses based in ICD-9 or SNOMED by 2011, according to the recommendations. The challenge with the electronic problem list is who owns and manages the list is always a matter open to debate, says Haughom. For example, primary-care physicians think they own and manage that information, as do specialists who do most of their work in the hospital setting (at least on the inpatient side). Like CPOE, the challenge for many providers is not implementing the technology but changing the culture. "The Office of the National Coordinator should give health systems and physician groups time to work out some of the cultural issues before they push too hard on the problem list," he says.