First Look at ‘Meaningful Use’

The meaningful use workgroup of the HIT Policy Committee has released its initial recommendations for a definition of “meaningful use” of electronic health records. The definition is important because under the economic stimulus law, providers must “meaningfully use” EHRs to receive financial incentives from Medicare and Medicaid.

These initial recommendations do not include a formal definition of meaningful use. But they are the initial recommendation of the functionalities that will be required by 2011 when incentives start. “This is the beginning of a conversation that will continue for some time,” said David Blumenthal, M.D., the national coordinator for health information technology, during a meeting of the HIT Policy Committee, a public-private advisory group. Blumenthal added that “there is a long way to go” before a final definition of meaningful use is achieved.

The workgroup’s initial recommendations include 22 objectives–most covering inpatient and outpatient care–for EHRs in 2011. These include, among others:

• Use CPOE for all order types including medications;
• Implement drug-drug, drug-allergy and drug-formulary checks;
• Maintain an up-to-date problem list;
• Generate and transmit permissible prescriptions electronically;
• Maintain an active medication allergy list;
• Send reminders to patients per their preference for preventive and follow-up care;
• Document a progress note for each encounter;
• Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies;
• Provide clinical summaries for patients for each encounter;
• Exchange key clinical information among providers of care;
• Perform medication reconciliation at relevant encounters;
• Submit electronic data to immunization registries where required and accepted;
• Provide electronic submissions of reportable lab results to public health agencies;
• Provide electronic surveillance data to public health agencies according to applicable law and practice; and

• Comply with federal and state privacy/security laws and the fair data sharing practices in HHS’ Nationwide Privacy and Security Framework, released in December 2008.

The HIT Policy Committee will make the final recommendations on meaningful use definitions to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

HHS is mandated to publish an interim final rule for standards, implementation specifications and certification criteria of EHRs that qualify for financial incentives by the end of 2009. CMS will develop the formal definition of meaningful use to support the incentive programs. CMS will go through the full administrative rules process with a proposed rule, public comment period and a final rule. A timetable was not given.

The recommendations from the meaningful use workgroup include a matrix of objectives for 2011, plus enhanced objectives for 2013 and 2015. The workgroup will refine the initial recommendations for 2011 and 2013 within three months.

The meaningful use workgroup also has laid out an “achievable vision” for benefits to be realized by 2015. These include reductions in heart attacks, medical errors, and preventable hospitalizations.

For more information, click here. Scroll down and click on “meaningful use preamble” and “meaningful use matrix.” Updates from certification/adoption and information exchange workgroups also are available.

Blumenthal: Meaningful use must result in quality improvement, more time at bedside, less duplication

HHS’ definition of meaningful use will include an organization’s ability to use health IT to improve quality and “inform clinical decisions at the point of care,” David Blumenthal, national coordinator for health information technology, wrote in an Oct. 1 letter to the industry.

CMS is expected to publish its formal definition of meaningful use by the end of the year. Expect it to require providers to use HIT to “reduce the amount of time spent on duplicative paperwork” so they can spend more time with patients, Blumenthal wrote.

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level,” he added. “As a result, we expect that any formal definition of ‘meaningful use’ must include specific activities healthcare providers need to undertake to qualify for incentives from the federal government.”

HITECH ‘Meaningful Use’ More About Improving Patient Care Than Tech Itself

Dr. David Blumenthal, the national health IT coordinator, is responsible for doling out government grants to reimburse health care organizations that implement electronic records technology. According to the HITECH section of the American Recovery and Reinvestment Act, nearly $22 billion in federal fundshas been set aside to “advance the use of health information technology.” A significant portion of that amount will take the form of grants to those health care organizations that can demonstrate “meaningful use” of such IT.

However, what exactly “meaningful use” will entail has been unclear. HHS is expected to release a definition in December, InformationWeek blogger Mitch Wagner says. But those who attended the Medical Informatics Association’s symposium got a “heads up” from Blumenthal on what that definition will focus on.

FierceEMR’s Neil Versel quotes Blumenthal this way:

The meaningful use framework will be about the goals of care, not the technology.

It’s a matter of using technology to improve patient care, not just installing the technology to say you have it. Versel speculates that the goal is to make electronic recordkeeping a best practice, the EMR system a standard medical tool, just as stethoscopes and examination tables are standard now.

Take, for instance, my own experience. I visited the local immediate care center over the weekend when I got tired of a wrenched neck muscle making my life miserable.I filled out the initial paperwork, listed my maintenance prescriptions, gave them the name of my primary care physician, the date of my last visit to her office, insurance information and all the rest. When they called me back, I gave my primary doctor’s name and listed all my meds and my medication allergies (again) for the nurse who took my temperature and blood pressure.

Then, guess what? The doctor came in, looked at my chart, asked again who my primary care physician was and what kinds of anti-inflammatory and muscle spasm medications had worked for me in the past, which ones irritated my stomach and which ones didn’t. After a little over an hour, I was out of there, prescriptions in hand, confident that the pain in my neck was about to go away.

All in all, it was a good experience — especially considering I would have waited at least twice that long if I had gone to the emergency room. But, I was reminded how helpful health IT will be. If the immediate care center and my primary care office had EMR systems that allowed easy sharing of patient information — with my consent, of course — then my visit would have been even quicker. I wouldn’t have had to go through the litany of information three times, and the doctor who treated me would have had my medication history at her fingertips, allowing her to make better informed decisions.

Blumenthal: Patient Care, Not Tech, Will Drive Meaningful Use

National health IT coordinator Dr. David Blumenthal dropped a big hint about upcoming criteria for giving out e-health records grants. He advised healthcare IT managers to focus on “goals of care” rather than technology.

Blumenthal works for the U.S. Department of Health and Human Services, which is responsible for giving out grant money to reimburse healthcare providers for implementing electronic medical records. The U.S. American Recovery and Reinvestment Act of 2009 (ARRA), which set aside the money, specified that the funding will go to “meaningful use” of EMRs, but did not specify a definition for the phrase. HHS plans to release a preliminary definition of meaningful use next month. But Blumenthal dropped a hint at an address at the Medical Informatics Association’s annual symposium. He “gave attendees what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare,” according to FierceEMR.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broader healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

Final standards for meaningful use will be released in the spring, after a period of public comment on the first effort to be released by the end of the year, according to a ModernHealthcare.com write-up of Blumenthal’s address.

Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

“It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”….

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

Privacy and security will be essential, he said.

HHS plans to announce the first round of recipients of two major rounds of grants soon, Blumenthal said. The first, for $700 million, will establish up to 70 health IT regional extension centers nationwide to help healthcare providers become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchanges linking providers.

HHS also plans programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”