Meaningful Use: All Stick and No Carrot
The initial reaction to the HIT Policy Committee's recommendations for the definition of "meaningful use" of electronic health records was shock and concern. I overheard phrases like:
- "It's more of a stimulus stick."
- "You have to walk before crawling."
- "It sets the bar so high; it forces us to game the system."
- "It doesn't show how the functionality required furthers quality goals."
Chief information officers were overwhelmed by the list of objectives for EHRs by 2011, which include
- Using computerized physician order entry systems for all order types including prescriptions in both outpatient and inpatient settings.
- Incorporating lab-test results into EHRs in both outpatient and inpatient settings.
- Generating lists of patients by specific condition to use for quality improvement initiatives, reducing disparities, and outreach in outpatient settings.
- Providing patients with an electronic copy of- or electronic access to- clinical information (including lab results, problem list, medication lists, allergies) in both outpatient and inpatient settings i.e. through a personal health record.
- Providing clinical summaries for patients for each encounter in outpatient and inpatient settings.
- Exchanging key clinical information with other care providers, such as problems, medications, allergies, test results in both outpatient and inpatient settings.
- Submitting immunization and laboratory data to public health agencies.
- Complying with HIPAA Privacy and Security Rules and state laws.
These objectives were centered around five desired health outcomes: Improving quality, safety, efficiency, and reducing health disparities; engaging patients and families; improving care coordination; improving population and public health; and ensuring privacy and security for personal health information.
Even though the policy committee was more aggressive in its first draft of recommendations than many healthcare executives expected—perhaps the committee was hoping to generate a lot of public comment—many healthcare leaders still applauded the goals of the committee.
"The healthcare industry is far behind other industries in this country. Therefore, the bar needs to be set very high in order to drive the industry to catch-up and get where we need to be," says Norm Mitry, CEO of Heritage Valley Health Systems, an integrated delivery network in southwestern Pennsylvania.
Peter Basch, MD, the medical director for ambulatory clinical systems at MedStar Health, an eight-hospital system based in Columbia, MD, agrees. "The HIT policy committee has to take a road where an incentive is an incentive," he says, explaining that it should put the goals within reach of early adopters or just outside of reach of average physicians and hospitals adopting HIT. "We don’t what to set the bar too low that the results of this massive investment by American tax payers in healthcare infrastructure goes to naught."
Still there is a real concern that the bar may be out of reach for many providers. "Hospitals will need significant clinical systems already in place to meet the proposed timeframes," says Catherine Bruno, vice president and chief information officer at Eastern Maine Healthcare Systems in Brewer, ME. "Even though these are health information technology objectives, they are really changing clinical practice," she says.
CPOE in 2011—really?
Not surprisingly, the two areas that seemed to cause the most consternation were the CPOE requirement and emphasis on PHRs listed in the 2011. Some hospital executives said that CPOE and medication administration using barcoding, which was listed under the 2013 objectives, should be flipped.