How Meaningful is Meaningful Use?

When President Obama signed the Health Information Technology for Economic and Clinical Health Act into law last winter, many of the physicians I spoke with were initially skeptical. Some didn't think the reimbursement was high enough; others were worried about administrative hassles. But most simply wanted more information about two undefined details: the requirements for meaningful use and standards for EHR certification.

The entire goal of digitizing and connecting healthcare depends on those two definitions, after all. If the bar is set too high, the selection of products will be limited and physicians will struggle to meet all of the requirements for reimbursement. But if it is set too low, we might see widespread adoption of systems that don't fundamentally improve delivery and coordination.

Last week, CMS and the Office of the National Coordinator for Health Improvement Technology (ONC) took the first step toward finalizing those key components when it released regulations for public comment defining meaningful use and setting certification standards.

So how did they do? Is the bar high enough? Just right? Too high?

The Medical Group Management Association thinks it's the latter, and immediately issued a complaint saying the rules "are overly complex and that medical groups will confront significant challenges trying to meet the program requirements."

The problem is with the timeline for some of the thresholds. The full meaningful use definition will be rolled out in stages, and the pushback is coming from physicians who want some of the requirements, like use of computerized prescription order entry, delayed until a later stage. The current definition calls for physicians to use CPOE for 80% of all orders in 2011 to qualify for reimbursement.

Other requirements that the MGMA and other groups think will cause administrative obstacles to implementation include:

• Insurance eligibility must be checked electronically for at least 80% of all unique patients
• At least 80% of all claims to public and private payers must be submitted electronically
• Providers must give 80% of patients who request it an electronic copy of their health information within 48 hours

It's not that these goals aren't important, but they will require some significant changes to basic practice operations and administration.

Not all physicians are so skeptical, however. My colleague Carrie Vaughan recently spoke with John L. Haughom, MD, who said that, "the ONC and CMS have set the bar at an appropriate level. While everyone does not agree with everything they are doing, it is very clear that the health IT agenda in the United States will be driven by the ONC agenda."

The American Medical Association has neither criticized nor praised the proposals, but says it will review them within the 60-day comment period.

Regardless of your opinion about the initial definitions, now is the time to state it. The long initial process of defining the measures for success and establishing criteria for reimbursement is coming to a close.

Soon, the focus will turn implementation and compliance. But for 60 more days, physicians have a chance to make meaningful use as meaningful as possible.