Meaningful Use: Defined by HIT Policy Committee

The IT community is one step closer to a definition of "meaningful use" of electronic health records since the HIT Policy Committee made its recommendations today to the Office of the National Coordinator for Health Information Technology.

I spoke with a number of executives to get their predictions and strategies regarding "The Meaning of Meaningful Use" for the June issue of HealthLeaders magazine. Since then, I've spoken to even more industry executives to get their thoughts on the phrase that has caused confusion, criticism, and alarm. Here are some excerpts from those conversations.

Will the bar on "meaningful use" be set too high or too low to improve quality?
That is a real risk, says Lynn Vogel, MD, vice president and chief information officer at The University of Texas M. D. Anderson Cancer Center. "Since these are 'stimulus' funds and likely a one time opportunity, I am concerned that there will be a temptation to expect that they will fix all that ails our healthcare system and that is completely unrealistic." It's not IT's burden alone to improve the quality of care, says Vogel, who is also the associate professor of bioinformatics and computational biology. "Hospitals should not be penalized if all they have done is to improve the caregiver's access to clinical data through electronic capabilities. That is valuable and 'meaningful' by almost any standard," he says.

The government will not hold organizations "hostage" to high standards, says Mark D. Crockett, MD, an attending physician at Morris (IL) Hospital and the president of the emergency care division for Picis, an Wakefield, MA-based IT software vendor. "It will be more of a carrot than a stick," he says. "They are looking to reward hospitals that are making moves—reporting quality and using some type of CPOE. They are also looking for information exchange."

Are the stimulus funds a big enough 'carrot' to spur quick adoption, or will most organizations just try to avoid penalties?
The answer is different for hospitals and physicians, says J. Marc Overhage, MD, PhD director of medical informatics and research scientist at Regenstrief Institute, Inc. and president and CEO of the Indiana Health Information Exchange. "For hospitals it is probably enough," he says. "For physician practices, by and large, it is not enough."

The combination of incentives from the Centers for Medicare & Medicaid Services and the American Recovery and Reinvestment Act removes any doubt that physician practices must adopt an electronic health record in the next five years, says Phyllis Schuck, CIO at Pinehurst Surgical Center. "The financial aspects are designed to encourage rapid adoption." But they don't "significantly offset" the capital outlays that an EHR requires, she says.

Overhage predicts there will be a large number of organizations in jeopardy of being penalized under the guidelines.

What will the impact be if a large number of organizations rush to purchase HIT in the hopes of securing stimulus dollars without putting in enough planning time?
Organizations could be wasting their money in the long run, if they buy IT just because there is stimulus money, but they are not ready or purchase a system that isn't what the caregivers need, says Vogel. "That's the challenge—and the risk—of the stimulus funding," he says. "Some number of these purchases will not be successful because the organizational context within which the system will be implemented will not be ready to make the changes necessary to be successful."

"Our biggest risk, is will we effectively use these dollars to deliver better care for patients," says Overhage. "If I can send and receive healthcare data, but no one else is out there to do it—the patients won't get any benefit." There is a critical mass that needs to be achieved for widespread adoption to occur, Overhage says. And while he's not sure what that figure is exactly, it is probably in the neighborhood of 60% to 70% of healthcare data that needs to be exchanged, he says.

Will there be a better approach to achieving meaningful use—enterprise path or best of breed?
Crockett is not convinced it will make a difference over the long haul. "Everyone wants to see an integrated system where all documents are visible and useful to everyone in the hospital," he says. Historically, that has only been achieved with enterprise systems, but organizations often have to sacrifice some level usability and effectiveness for clinicians with those systems. One system can't do everything well, says Vogel. For some organizations having a single system is worth avoiding the hassles associated with a best-of-breed approach. Then again, for other organizations like academic medical centers where state-of-the-art capabilities are expected in every area, the only way to accomplish that is through best of breed, says Vogel. "Just like in cars, a high performance racing vehicle is not the best vehicle for commuting to work every day, and the best car for your daily commute would run far back in the pack on the race track."

Crockett believes the solution is in interoperability standards. "If I needed to achieve meaningful use in one year, I have no choice but use one vendor," he says. "But if I can do this over time as standards are put in place, then I can buy a system from anyone and have it work."

The HIT Policy Committee will offer some additional direction with its recommendation to ONCHIT, but the industry will still be in a holding pattern until it receives the official definition. Then, it will be a race for "meaningful use" status and cold hard cash. Will most organizations take the time for planning to ensure they get the value out of the IT being implemented—improved outcomes and cost savings—even if that means forgoing some stimulus money? Or will they speed up the decision-making and planning process in order to go for the cash and hope to sort it out on the backend? I must admit, I think there will be some definite redo's from organizations that didn't quite find a system that fits their clinicians' needs.