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23
April, 2014
Wednesday

Meaningful use, where is the patient?

In March this year the issue of meaningful use appeared in the USA EHR implementation discussion. The ICMCC News Page has an extended overview of meaningful use related articles. In the beginning the discussion was descriptive, not defining. Aspects like e-prescription, interoperability and electronic exchange where considered essential elements (Ryan Ricks, 7 April 2009; John Moore, 24 April 2009). HIMSS added certification to it. (HIMSS, 24 April 2009).
A few days later the HHS shifted slightly: “include interoperability, the ability to report standard quality measures, and advanced clinical decision-making” (Ken Terry, 29 April 2009). Early May, John at EMR (EHR) and HIPAA gave a nice overview of the ongoing discussion.

I will not go through all the articles dealing with meaningful use, the ICMCC News Page has over 180 of them. But important is to mention that by the end of May through an article by Kibbe and Klepper, quoting my friend Don Kemper, the patient finally entered the discussion. Bob Coffield gave an overview of the patient’s aspects on 4 June 2009 followed by Josh Seidman (5 June 2009).

One of the first to put it loudly is Lygeia Ricciardi, “Meaningful Use” Means Including Patients (15 June 2009). According to Halamka, the final definition as put forward by the HIT Policy Committee on June 16, includes “Engage Patients and Families” which was interpreted as “that in 2011, patients will begin to read their records online, in 2013 they will begin to write their records online, including via secure messaging with their providers, and in 2015, there will be full real-time access to a personal health record populated with their data” by Ted Eytan (26 June 2009). At the same time (22 June 2009) the discussion on ownership started (see also here for an overview of articles on the ICMCC News Page), which unfortunately has become quite silent recently. Internationally, the move towards ownership was already initiated in 2007 by ICMCC in its “WHO Guideline on Patient Record Access“, which we are now discussing with the WHO.

Early August, Lygeia Ricciardi correctly states that “Further Clarifications are Needed to Make Data “Meaningful” to Patients“.

On September 30, Dr. David Blumenthal (USA National Coordinator for Health Information Technology) published ““Meaningful” Progress Toward Electronic Health Information Exchange“.

Here the full text:

I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).

Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.

The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.

As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.

The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”

ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.

CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.

By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.

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

Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.

What’s next?

As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for Medicare and Medicaid incentives.

In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted at healthit.hhs.gov/meaningfuluse.)

Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.

To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.

There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.

I look forward to providing periodic updates, and to continued interactions with all the communities that have so much to gain from this profound transformation.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

The patient-related quotes:

  • “Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.”
  • “Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day.”
  • “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.”
  • “The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.”
  • “We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics.”

Where is the patient and his participatory role?
Let me know what you think.

Lodewijk Bos

2 October 2009 | Categories: Blog.
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2 Comments

  1. paul roemer says:

    I think three years from know we will see that meaningful use proved to be a smokescreen which demonstrated no meaningful use.

    I also think there is benefit in looking at why healthcare providers have to be offered money and subjected to potential fines to do something that is supposed to be good for them. In turn, why do they then need to be pushed into rolling it out according to someone’s timetable who’s not even a part of their organization.

    1. Why are providers running from EHR instead of towards EHR?
    2. Why do they have to be paid to implement EHR?
    3. Why do they have to be cajoled to roll it out according to somebody else’s time table?

  2. Lodewijk says:

    Paul, you raise legitimate questions. Some of them are typical for the US situation as the financing of healthcare is so different. But there is one element that seems to be universal, we have not been able to really explain to people, either professional or patient/citizen, what the benefits are.
    And IMHO it was a mistake to leave the patient out of the decelopping process for such a long time, therefore neglecting aspects of safety, confidentiality and access (on both sides).

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