Meaningful Use - Part 2 Intro

The Notice of Proposed Rule Making (NPRM) for Stage 2 requirements for meaningful use of electronic health records (EHRs) was released by the Centers for Medicare & Medicaid Services (CMS) on February 23, 2012. There will be a 60-day comment period starting on March 7, and then a final rule will be published. The final rule is expected in the summer of 2012. Here are some key links and summaries:

• CMS EHR Incentive Program Overview
• CMS EHR Meaningful Use Overview
• CMS EHR Meaningful Use FAQs

Hints if you want to submit anything to CMS (from a HIMSS meeting with the CMS folks):
1. The best comments are well thought out explanations based on evidence whenever possible.
2. It is fine to comment as an individual, but of course it's more powerful if you comment as the consensus of a larger group.
3. Make sure to comment on both the pros and the cons.  If you just comment on the cons - then CMS needs to just focus on fixing those.  In other words, if you like something - let them know that too... otherwise someone who does not like the same thing will have more sway if they comment negatively about it and no one comments positively. 


Things I like include focus on CPOE and messaging.
Things which worry me include:
- The increase in eRx from 40% to 65%: As there are still many patients who want a printed Rx since they are not sure of their pharmacy address or want to shop around first; and not all pharmacies or PBMs accept eRx.  It's actually easier for docs to do eRx than print... but CMS has to understand that not all patients or pharmacies are ready for eRx yet.  Maybe going to 50% is a good compromise.
- Imaging requirement: As a PCP, do I really need to view the images of an xray... I am quite happy just seeing the report.  I don't think I am going to see anything the radiologist did not!  I am not sure if they are saying this requirement is for both inpatient and outpatient.
- Med Reconciliation: If a requirement for ambulatory care - I am curious on how they monitor it. On one hand, I do this every time I see a patient.  On the other hand, I don't use a special function to do this... so I am not sure how we measure it.
- Structured Family History: I am curious as to whether this will mean vendors create a new functionality for this since we've been using an older functionality for 10 years... and they might find it is easier to meet the letter of the law by using a new function rather than support an old one.

High level Summary (per HIStalk Blog)

The broad themes to be addressed in the Notice of Proposed Rule Making for Stage 2 are:

• Increased emphasis on health information exchange.
• Increased emphasis on patient engagement.
• New requirements for hospital patient safety, specifically with regard to electronic medication administration records.
• Requirements involving tying clinical decision support to quality measures.
• A philosophical goal of flexibility and reducing provider and vendor burdens.

Specific issues are:

• The Direct protocol will be required.
• SNOMED will become the standard for encoding problem lists.
• Infobutton (i.e. the blue button initiative) will be expanded, with requirements that patients be able to view, download, and exchange their own information. The proposed legislation calls for 10% of patients to actually do this.
• While Stage 1 required theoretical information exchange capability in test mode, Stage 2 will require providers to exchange information “across organizational and vendor boundaries,” which also includes submission to public health agencies.
• Encryption and usability requirements will increase.
• Viewing of images will be supported as an optional item.
• Physicians in group practice will be allowed to submit their quality measures electronically as a group.
• Stage 1 will be extended for another year, though 2013 for those who first attest in 2011. Providers can then stay on Stage 2 for another two years.
• The last date to attest without penalties will be October 1, 2014.
• An increased emphasis will be placed on making referrals electronic.
• Electronic submission to cancer registries will be added as a menu item.

  

SUMMARY OF KEY PROVISIONS IN PROPOSED RULE 

FOR STAGE 2 OF MEANINGFUL USE

(per a memo from the Global Institute for Emerging Healthcare Practices at CSC)

This memo provides a summary of the most significant changes and clarifications in the rule. A more detailed white paper will be published later. The Stage 2 proposed rules for meaningful use have many changes — some are subtle.

In addition to the new requirements to be a meaningful user of EHRs, there is one important clarification to the requirements for avoiding penalties. To avoid penalties starting in 2015 for not being a meaningful user, hospitals and eligible providers (EPs) need to either attest to meaningful use in 2013, or have achieved and attested to the first year of meaningful use by July 1, 2014 (October 1, 2014 for EPs).

As reported earlier, the requirement as to when different Stages of meaningful use need to be met was officially relaxed. Those that attest to meaningful use first in 2011 must meet Stage 2 criteria in 2014 and Stage 3 in 2016. All others will be required to demonstrate 2 years at Stage 1, 2 years at Stage 2 and then 2 years at Stage 3 (assuming the cut-off date for the program’s payments have not passed).

Quality measures are still not final, but in 2014 they will be submitted electronically. Quality measures are now a distinct category of meaningful use and the schedule is not tied to a particular Stage. In 2014, all those attesting to any Stage of meaningful use will need to electronically report the 2014 quality measures. The proposal is that EPs will submit 12 measures (some may be required, others selected from a long list of potential measures). Hospitals will select 24 measures (50 possible measures are proposed). In both settings, at least one measure will need to be reported from each quality domain: patient safety, care coordination, population and public health, efficient use of resources and clinical effectiveness. The final list of quality measures will be published with the final rule. This delay affects both users and vendors, vendors are likely to require significant development effort to be able to capture and report on the expanded list of quality measures.

There are many changes in requirements. The proposed rule generally makes Stage 1 optional (menu) items required (core) in Stage 2. Stage 2 does retain the concept of core and menu requirements for new requirements; for example use, of e-MAR is now a core requirement for hospitals and the ability to view images is a new menu requirement. Many of the thresholds from Stage 1 have been raised — some to a higher level than those recommended by the HIT Policy Committee. For example, the requirement for CPOE for medications is 30% in Stage 1, the Policy Committee recommended it be raised to 50% and the proposed rule raises it to 60%. Other new requirements include CPOE for laboratory and radiology orders, the ability of patients to view, download and transmit their health information, and public health reporting to cancer registries and other specialized registries. The CPOE measurement was changed from being based on one order per patient to a percentage of all orders — which will raise the bar considerably.

The only major recommendation from the policy committee that was not included in the NPRM was for an electronic physician note for 30% of office visits and 30% of hospital days. While no longer required for meaningful use, physician notes are a major source of data that will be required for electronic reporting of quality requirements.

To ensure that systems certified for Stage 2 can also meet Stage 1 requirements, a few Stage 1 requirements will be modified somewhat for 2014 onward. All the changes in requirements (even small ones) will have a major impact on vendors, since the entire installed base will need systems that meet these requirements. It is likely that vendors will only have the more recent versions of their products certified for Stage 2 — increasing the number of customers that will need a major upgrade.

The table below provides a summary of all the changes in requirements proposed for Stage 2. Hospitals will have 16 core (required) measures and must select two of four menu (optional) objectives. EPs will have 17 core objectives and be required to select three of five menu objectives.

Summary of Requirements for Stage 1 and Proposed Changes for Stage 2

Requirement	Stage 1 Final Minimum Requirement	Stage 2 NPRM Minimum Requirement
Maintain medication, problem/diagnosis, allergy lists	80% of patients have an entry or indication of none	No longer separate requirement, must be included in the electronic record for patient access and transmitted at transitions in care.
Demographics recorded	50% of patients	80% of patients
Vital signs recorded	50% of patients over 2	80% of patients over 3
Smoking status recorded	50% of patients over 13	80% of patients over 13
Family history	Not required	Menu item: 20% of patients have family history recorded as structured data
Computerized Physician Order Entry (CPOE)	30% of patients have a CPOE medication order if they have any med orders	60% of medication, laboratory and radiology orders entered using CPOE
Info on Advanced Directive	Menu option for hospitals — indicate if patent has advanced directive for 50% of hospitalized patients 65+	Remains menu item for hospitals.
Drug-drug and drug-allergy checking	Enabled	Enabled — now combined as one requirement for decision support
Drug-formulary checking	Menu option	Incorporated as a requirement for e-Rx
Medication reconciliation	Menu option, performed for 50%	Required
e-Prescribing	40% of prescriptions for eligible providers	Required — 65% of prescriptions for eligible providers Menu 10% of new or changed medications for discharged hospital patients, must include a drug formulary check
Summary of care record transmitted between providers at transitions in care	Menu option, performed for 50% of transitions (can be on paper)	Required for 65% of care transitions; must be electronic for 10%
Ability to view images	No requirement	Menu option: 40% of all scans and images available for viewing on the EHR
Secure messaging	No requirement	10 % of patients have sent at least one message to eligible providers
Electronic medication administration (eMAR)	No requirement	Required for 10% of all medication orders for hospital patients

Other Useful Links

• Summary from American Medical News (3/5/12)
• Summary from Unchart.com
  

Welcome to 2012!

Wow… I am officially in awe of all bloggers who can post once a day, once a week or even once a month at this point.  I have clearly fallen off the horse - but am saddling up again for what looks to be an amazing 2012!   Yeah, I've been a bit distracted - helped start up a new HIT company (more to come), am working on a book highlighting the intersection of HIT and Innovation, and am juggling all the regular doctor and CMIO type of things.  BUT - no excuses… I've got to find some time to get my thoughts down!

I actually have a couple of blogs half-written in emails to myself, but I'm going to start with something more current… my take on various stories from one of my favorite blogs - HISTalk.  In their recent blog, they mentioned the following three stories (among others), and I thought each had some major importance so I want to highlight them and give my 2 cents:

First, Meaningful Use (MU) Attestation
CMS has provided the database for the statistics on numbers of physicians who have currently attested for MU.  Modern Healthcare did a nice breakdown in their story on it:

·    For Ambulatory:  Epic was the EHR of choice for 6,045 physicians and other eligible professionals, grabbing a 28% market share of the eligible-professionals segment, a slice larger than that of the next four vendors combined.  Those others in the top five, in rank order, are eClinicalWorks, 1,847 (9%); Allscripts, 1,449 (7%); Athenahealth, 1,158 (5%); and Community Computer Service, 999 (5%).  These top five vendors claimed 54% of the market of early adopters and meaningful users.  The top 10 vendors also claimed 71% of the incentive payments thus far.  But it's still a wide-open market.  The database lists 217 EHR vendors as having products that had been used successfully by at least one eligible professional to either achieve meaningful use or receive incentive payments under Medicaid.  Of those 217 developers, 131, or 60%, had 10 or fewer installations.

·    For Acute Care (Hospitals):  Epic also led among hospitals that received federal incentive payments for using a complete EHR, but the privately held company was not nearly so dominant in this indicator of the hospital IT market as it was in the EP segment.  According to federal data, there were 627 hospitals that have been paid using complete EHRs developed by 22 different companies or organizations.  Of them, 165 were Epic customers, 26% of that niche.  Ranked second was Computer Programs and Systems, commonly known as CPSI, used by 140 hospitals (22%), followed by Cerner Corp., 71 (11%); Healthland, 54 (9%); and Meditech, 47 (7%).

Mr.HISTalk said the following:  Here’s a point/counterpoint issue to mull over.  Inga and I disagree on the value of CMS’s attestation statistics.  Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements.  I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money.  Feel free to take sides.  One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Here was my response:  I'm siding with Inga on this Point/Counterpoint… although the numbers are not perfect - they should provide value in two ways:

1. Totals. A general idea about the total number of real EMR users.  I’m sick of the vendors each claiming to have 50-100K users.  Sorry - there are only about 600K total active doctors… and only 25% using EMRs – so you are all splitting about 150,000 docs at best right now.  Although this initial data is a good start, I think very soon we will get a much better idea of how many docs are attesting with each vendor (since many are waiting until end of 2011) and then at least the general proportions will be easier to assess… will it be EPIC with 30%, and the next tier of 5-6 vendors at 5-10%, and then 210 more with under 1% each… or will we see a surprise pop up somewhere?!??!

2. Successes.  Fair enough – it is possible some EMR vendors will have a higher percent of attestations because they are better at implementation, etc… but hey - that’s OK, I think that is a key indicator too… and am fine if that “biases” the numbers.  But they are still valuable.

Second, Most Online Diabetes Management Tools are Ineffective

CMIO Magazine did a nice summary of the JAMIA study.  It turns out that over 75% of the time - the tools were NOT clinically useful or usable (or said another way- they were only useful and usable 25% of the time).  But perhaps more importantly was the second finding which is that patients just don't use these tools consistently.  Hey - that should be a surprise!  Yet it may shock or offend some in the "consumer empowerment" community who keep saying patients want more tools to use online.  While I think a subset do want these, it is just not the majority.  Unfortunately, the reality is that any tool or business model that relies on behavior change is a really tough sell.  Patients have shown for a very long time how resistant they are to change, and just having a website or app telling them what to do is not going to make that magically happen.  I do look forward to the next slew of websites claiming to have that "secret sauce" that will make patients change (e.g. games, rewards, social interactions), but think that the vast majority of folks who try to crack that code don't fully understand human behavior, especially as it relates to health.  It is much more complex than buying stuff online, banking and Facebook... but I do think we are getting better - and a well researched article like this will help us continue to move in the right direction.

   

Finally, "Smart Contact Lenses Keep Eye On Your Health"… Sensors are here baby! 

This news story asks "What if the lenses could look inside of you to diagnose, monitor and even treat disease? Sound far-fetched?  Well, it may not be too far away… The new generation of contact lenses is being called “smart lenses”, and they are packed with circuits, sensors and wireless technology – all designed to "keep an eye on your health".   It is indicative of a big and growing trend towards ubiquitous biomedical devices, especially involving sensors, which we will be hearing more and more about in the months and years to come.   Of course, it pairs well with the other big trend around big data - because this many sensors are going to need some major analytics to make them useful. 

Bottom line - there is so much amazing change and innovation going on in healthcare, cannot imagine a better industry to be in for the next few decades!!!

DC Hearings for Meaningful Use

I went to DC earlier this month to speak at a governmental "hearing" about Meaningful Use.  Since the Feds are about to spend up to $40 billion on creating incentives for EMRs - I give them credit for wanting to make sure they hear as early as possible if there might be problems with their program.

I blogged about my experience at the HISTalk Blog, so full details are here:
 http://histalk2.com/2011/01/18/the-mu-hearings-drlyle-goes-to-washington-11811/

For those who just are looking for a quick summary, here you go:
ONCHIT's Implementation Committee wanted to hear from Eligible Providers (EPs) and Hospitals about their early experience in preparing to meet MU requirements for this year. 

The good news is that this bill has indeed "stimulated" many organizations to move forward with various upgrades and focus on how to produce quality reports from the data in their EMRs.  But mostly we heard about the challenges:
• This is hard. It’s not impossible, but it’s a higher bar than many had anticipated because the requirements are not simple, nor are they fully explained.
• Time crunch. There is a very tight time frame between the release of the requirements, embedding them into EMRs, the "rollout" of the new EMRs, and the updating of workflows and reports to ensure users are actually meeting the MU requirements.
• Resource crunch. This is often a zero-sum game with resources.
• We need more flexibility. Not every practice is the same, and requiring 100% mandate of every requirement is not reasonable.
• Functionality is not the same as usability. An EMR vendor can get MU certification for their functionality whether their usability is great, good, or poor. Fortunately, the government is starting to look into usability requirements for the certification process, so let’s hope they follow through on that sentiment.
• Standards. "We’d rather have one bad standard we can work with than three good ones without a clear winner." On the other hand, we should make it clear we do NOT want the government to make standards about actual functionality – we can and should be creative in that domain.
• The cost of implementing MU may often be more than the actual monies themselves, when you factor in costs for various software upgrades, consultants, and change management.
• Certification requirements don’t always exactly match MU process requirements. Someone has to keep a better eye on this.
• Communication with CMS and ONCHIT has not been easy.
• The result of most of the above is that the biggest and the best are struggling with MU… so you have to wonder, how much harder will it be for others?

It has been interesting that this is in stark contrast with recent ONCHIT announcements about a recent survey showing that the majority of doctors plan to apply for MU.  However, let's be serious - most docs don't even know what MU means, and less than 25% even use a "basic" EMR (and under 10% use an "advanced" EMR).   So if a doctor gets asked, "Do you plan to apply for free money from the government for using EMRs in the coming years?"... it should not be a shock that most will say, "Sure, I'll give it a try."  

I know ONCHIT is trying to keep an optimistic view here, but I wished they spent some time at these hearings listening to real world users and less time crowing about a survey asking a hypothetical question.  In fact, no one from ONCHIT actually came to these hearings - even though they paid for people from all across the country to fly in (to be fair and balanced, someone from ONCHIT did listen on the phone during the morning session, and the Committee did summarize and report to ONCHIT later on).

I think we all agree that ONCHIT's goals are noble, but if they don't get feet first into the reality of the situation, they will have a hard time getting there - these hearings were a good step in the right direction, and I hope they continue to keep their ears on the ground and make adjustments as appropriate.

Relevant Links
- Full details and testimonies from the hearings
- Review of the different types of ONC Certifications

HITECH Showers...really, how come we aren't just focusing on Paying for Value?

I am involved with the Association of Medical Directors of Information Systems (AMDIS), and our list-serv often brings up good topics. I'll often post my thoughts, with my bias of being a very pragmatic, in-the-trenches primary care physician. I've incorporated some of those thoughts into past posts, but will also occasionally blog the (almost) verbatim posts I've made.

Here is a recent one I wrote, in response to discussions about whether the government is doing the right thing by using the HITECH funds ($39 billion) as "EMR Stimulus money" vs. thinking about restructuring how we pay for care so that EMRs will actually make business sense for physicians:


Yep- we've said it all before, the government (and other payors) need to pay for value, not volume. Align the healthcare system wisely, and there is no need for "stimulus dollars" to push for something which does not make business sense in today's environment. Make it valuable for us to practice high quality medicine - and that will happen… and in fact, the level of innovation in making that happen will be much greater than by trying to force untested EMRs onto everyone… it will mean more teamwork, more clinical standards of care, more checklists, more follow up, more competition…

What I don't get is that almost EVERYONE in healthcare policy knows this to be the case - and yet neither the HITECH bill nor the current healthcare legislation really touches on this.

Yes, there is some money for "experiments" - but we need payment reform as one of the foundations for care improvement. Can you imagine how much better the EMRs and other IT applications would be if they were being created in a world where payment didn't:
1. Rely on massive documentation of visits for any payment - and forced doctors to be the one to do this documentation themselves
2. Insist only doctors to be the ones to deliver care
3. Encourage volume over value

Take away those three restraints and replace with these two tenets… and just imagine what would happen:
1. Allow doctors to be part of a team that took care of patients as a whole - the right type of provider can do the right type of care and document in the way that makes the most sense for care
2. Encourages value over volume - so you can take care of many more people, but actually see less people

Sorry… dreaming again…

So what will happen in the meantime? Smart EMR companies will hopefully start making products that at least allow for better efficiency…It's hard to believe how poorly they have done in this arena to date… mainly all they have done is make it easier to document for higher level visits.

But in this real world, I do give HITECH some credit - MU is painful to look at right now, but at least it is making EMR vendors think more about how their systems can deliver quality. And while the overall reimbursement system has not yet caught up, it is fulfilling its promise of being a "stimulus".

The question will be whether this will be more like the April showers bringing May flowers… or a hailstorm that f's up your car.

Meaningful Use Final Matrix Posted

HHS has issued proposed final regulations that list the "meaningful use" criteria which healthcare providers must meet in order to quality for the HITECH incentive payments. This story from Health Data Management has a good breakdown of the Matrix, starting on page 26:
http://digital.healthdatamanagement.com/healthdatamanagement/201002?pg=6#pg26

Quick impression is that the bar is set low in some areas, but higher in other areas. Also, it is not fully clear how to fulfill the criteria. For example, one "box" says to have drug-drug interaction checking (which is pretty routine), but in the same box it says to also have drug-formulary checking... that is much more complex, and involves extra fees to the EMR vendor, as well as an assumption that the system allows for input of a patient's drug benefit plan (which is often different from their insurance).

Other confusing things include allowing patients "timely access" to their healthcare data, and something that says "Reminder sent to at least 50% of all unique patients seen by the EP that are age 50 or over" - reminder about what exactly, and does it matter how/when/where we remind them? But it's a start and I assume there is clarification in the other 553 pages of this document, but I'm just looking at the Matrix for now.

Other good links
* Dr. Blumenthal's summary of all the HITECH monies are going:
http://healthcarereform.nejm.org/?p=2669

* MU summary from Mr. HISTalk:
http://histalk2.com/2009/12/30/onchit-releases-preliminary-definition-of-meaningful-use/

* An MU Excel Spreadsheet created by Mr. HISTalk:
http://drop.io/meaningfuluse/asset/meaningful-use-xls

* Dr. John Halamka's MU Summary:
http://geekdoctor.blogspot.com/2010/01/achieving-meaningful-use.html

* Matrix of Numerators and Denominators
http://mycourses.med.harvard.edu/ec_res/nt/36980CA6-E154-4820-A0ED-8B235138B79F/measures.pdf

Key Websites for Meaningful Use

CMS - HIT Overview
http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

HHS - Meaningful Use Overview
http://healthit.hhs.gov/portal/server.pt?open=512&objID=1325&parentname=CommunityPage&parentid=1&mode=2

HHS - Meaningful Use Matrix
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_876940_0_0_18/Meaningful%20Use%20Matrix%2007162009.pdf

AMDIS Overview Site
http://www.meaningfuluse.org/

Meaningful discussion on Meaningful Use

I've been wanting to expand my comments on the meaningful use criteria for awhile, and has this piece posted last week on the HISTalk Blog:
http://www.histalkpractice.com/2009/08/25/drlyles-meaningful-discussion-about-meaningful-use-82609/

Basically, it's my view of the criteria and proposed definitions - with some suggestions on how to help ensure the intent in a more realistic manner.

Meaningful Use - The Start

The initial suggestions for Meaningful Use (MU) definitions have begun. This Matrix reviews the different categories and the Goals, Objectives and Measures in each one.

My initial thoughts were that the objectives were much too specific - they were defining the "means", not the "ends". However, with input from others, I then understood the gold is in the column titled "measures" - that is actually what will be defining whether someone gets their incentive bonus. At a high, strategic level- those seem closer to "ends" rather than "means" - which is satisfying since it allows for much more creativity and innovation in getting to those means.

On the other hand, I am not saying that they can all be done without many of the objectives- but hey, that is part of the cool thing about innovation – we don’t know yet what new ideas and technologies might pop up to better solve these problems. For example, instead of a doctor maintaining a med list at the point of care, perhaps a Data Warehouse collects all the billing codes, lab results, and meds from the pharmacies – and then uses some artificial intelligence to auto-create a problem list which can be used to create registries. In fact, that might be more accurate than relying on physician entered problem lists that are often pretty poor. In other words, there has to be some access somewhere to electronic data to make this work, but it does not all have to be physician entered into a single EMR…

So now we can dig into the details and ask some obvious questions:
- Are these the best measures, some are easily defined (eg % diabetics with HbA1C), but others do not have metrics captured in such an objective fashion (eg % smokers offered smoking cessation).
- We need more details about the format of these reports, and how we report them
- Will the government require all of them, or just a limited amount of the reports listed (similar to PQRS in which we only have to report 3 from a larger list).

I'll also make one suggestion - to include the concept of physician to physician messaging, both within an EMR, and across EMRs. I think that may be as or more important than sharing things like medication lists! But I did not see anything in any column in any year that talked about this really important functionality… they talked about access to shared data, but not about ability to send messages to doctors within your direct organization, or within your greater organization. I realize this may be looked at as more of a functionality, and thus contradicts my aversion to focusing on the “means” – but I hope somehow this is included.

Finally, the CCHIT folks have stated they will expand their defintions of certified EHR technologies- which is a good thing (assuming they set the standard to be used by HITECH). The result is that a variety of innovative approaches can then be taken to achieve meaningful use: Some docs will use a full functioning unified EMR, others might use a home grown system that patches together multiple components, and still others might just use HIT on the backend to reach the majority of the metrics required. In other words, it will be interesting to see how many of the measures could be achieved without requiring a physician to touch a keyboard at all (eg no data input). If we can accomplish that - then we may get both significant and meaninful use!

The HIT Policy Committee will accept public comment through June 26 on the just-released draft description of "meaningful use" of electronic health records. Comments should not exceed 2,000 words in length. Electronic comments are preferred and should be addressed to meaningfuluse@hhs.gov, with the subject line "Meaningful Use."

MeaningfulUse.org

"May 12, 2009--Compuware Corporation (NASDAQ: CPWR) and the Association of Medical Directors of Information Systems (AMDIS) today announced that they have joined forces to launch www.meaningfuluse.org. This collaborative web site will promote and advance the national dialogue and education around “meaningful use.” The new site gives the healthcare information technology (HIT) community a single, central location to access resources, collaborate, influence and discuss the definition of “meaningful use” and to learn how to take advantage of the HITECH Stimulus funds."

There may not be two more important words in the english language right now. How they are defined will affect if/how EMRs are fully adopted and whether they are used in a way that truly makes a difference... In other words, the very fate of our healthcare system may rely on how this is defined in the weeks and months ahead.

How should we use $36 billion to promote EMRs?

Journalist Joe Conn is one of my all time favorite HIT writers - especially because he has the talent to take my ramblings and put them into excellent articles, like this one he just published at the Modern Healthcare web site... or if that does not open, you can find it on my DrLyle website.

I was talking about the government plan to reward doctors with $36 billion in incentive bonuses for using EMRs in a "meaningful manner" - first, I'm all for using EMRs meaningfully, and second, I'm all for rewarding physicians! However, I was warning that our current crop of EMRs are far from perfect and was saying to make sure that we reward the right thing (quality and efficiency, not simply use of IT). I like how John Halamka, M.D. and CIO at CareGroup Health System in Boston defined "meaningful use" during the recent DC Hearings on this topic: “Processes and workflow that facilitate improved quality and increased efficiency.”
Additionally, I was questioning whether we could spend that $36 billion a better way- perhaps by creating a national EMR framework upon which vendors could build their applications (yeah- sort of like the iPhone). Hell- for $36 billion, the government could buy up the EMR divisions of Cerner, GE, Allscripts, and many others and then get everyone on one system!

Meaningful Use Committee meetings

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS
EXECUTIVE SUBCOMMITTEE
Hearing on "Meaninful Use" of Health Information Technology
April 28 - 29, 2009
http://www.ncvhs.hhs.gov/090428ag.htm

This is really an important time for EMR vendors and users... starting to define "Meaningful Use" - there will be immediate implications for the HITECH bill, but even more resounding implications for the future of EMRs in so many ways. My fear is that they focus on adoption of certain technologies and workflows (e.g. "Physicians must personally use electronic prescribing"). My hope is they focus on realistic outcomes (e.g. risk adjusted ER visits, hospitalizations, and specialty visits; and/or standard metrics like preventive care guidelines, lab results, etc...).

I don't think we need to mandate physicians directly using EMRs, we need to reward effective use of systems that improve quality in whatever manner works. This will invariably mean use of IT, but it can be in many different ways. Keep the eye on the outcomes, not the means...