Definition of Meaningful Use

We’re all still sitting here waiting for the government to finally decide two key terms in regards to gaining access to the $18 billion in stimulus money in the HITECH act (ARRA). I’ve been interested in the subject myself since before it was even settled that we’d call it meaningful use as opposed to meaningful EMR user. From the looks of that post back in February, there was still a lot of confusion about “meaningful use” and “certified EHR.”

Turns out that a few months later, we still have very little clarification about what these two terms mean. Certified EHR discussion has really revolved around CCHIT certification or some other alternative. We’ll try to leave that discussion for other posts. What has been interesting is in just the past week or two there has been a literal flood of people offering their perspective on meaningful use. Sometimes I like to be on the cutting edge of these definitions (like I was in the link above) and other times I like to sit back and let them play out. This time I’ve been letting it play out and it’s really interesting to see the multitude of perspectives.

I’m not planning on writing my own plan for how they should do meaningful use. I may do that at a later time if so inclined. For now, I’ll just focus on highlighting points from what other people have suggested and provide commentary that will hopefully enhance people’s understanding of this complicated mandate (yes, that means this post will be quite long).

I think it’s reasonable to first point you to the NCVHS hearing on “Meaningful Use” of Health Information Technology. This matters, because at the end of the days hearings like these are where most of the information are going to come. Then, with the information from these hearing decisions will be made. The other sources like blogs won’t carry nearly as much weight (although it’s unfortunate that more politicians aren’t listening).

John Chilmark on Meaningful Use
Next, I’ll go to one of my newly found favorite bloggers named John Chilmark (any coincidence we’re both named John). John from Chilmark Research commented that HHS is bringing together the “usual suspects” to discuss “meaningful use. Chilmark also states that the following criteria are what’s required for meaningful use:

  1. Electronic Prescribing
  2. Quality Metrics Reporting
  3. Care Coordination

I’m not sure where he got this list, but this list feels kind of weak if you ask me. In fact, John suggests that these requirements will be simple and straightforward and first and then ratcheted-up in future years. Interesting idea to consider. I hope that they do draft the requirements for meaningful use in a way that it can be changed in the future if it turns out to not be producing the results it should be producing.

John Halamka on Meaningful Use
Next up, the famous John (another John) Halamka, Chief of every Health IT thing (at least in Boston), calls defining “meaningful use” “the most critical decision points of the new administration’s healthcare IT efforts.” He’s dead on here. In fact, it might not be the most critical decision for healthcare IT, but for healthcare in general as well. Here’s John Halamka’s prediction for how “meaningful use” will be defined:

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Basically, he’s predicting inter operable EMR software and ePrescribing with a little decision support sprinkled on top. I won’t be surprised if this is close to the final definition. The only thing missing is the reporting that will be required to the government. The government needs this data to fix Medicare and Medicaid (more on that in another post).

Blumenthal Comment to Government Health IT
Government Health IT has a nice quote from David Blumenthal that says: “The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.”

I think there’s little doubt that David Blumenthal has a good idea of the importance of the decisions ahead. What should be interesting is to see how involved Obama is in these very important decisions. I’m guessing Obama won’t do much more than sign a paper to make it happen. I just hope I’m wrong.

HIMSS Definition of Meaningful Use
Here’s a short summary of the HIMSS definition of “meaningful use”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures – and other measures – as selected by the Secretary of Health and Human Services.

Basically, e-prescribing, interoperability and clinical decision support. Turns out a BNET Healthcare article suggested the same conclusion “The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making.”

I think we’re starting to see a bit of a pattern here. I should say that these are all very good things, but the challenge I see is that any requirement needs to be easily and consistently measured. Interoperability and clinical decision support are both very difficult to measure. Just wait until they see the variety of software that tries to do those two things. It’s very difficult to measure it consistently across so many EHR software.

Wow!! I barely even got started on this subject. Instead of belaboring the point, let me just point you to some other interesting readings about the HITECH Act, ARRA, and “meaningful use.”

Please let me know if there are other good sources for perspectives on defining “meaningful use.” This really is a landmark decision for healthcare IT.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • Wow, those seem pretty thin for requirements for meaningful use. I can understand why, from a policy standpoint, that they want to start general, but then again, it leaves an awful lot of room for questions, and ultimately error. I understand why the three specific elements are repeatedly being called out, but in a lot of instances we go bumping right back into interoperability – “care coordination” is extremely generic, and could expand to include interoperability — and in some instances, based on the implementation, a system that may be able to handle care coordination, may not be able to.

    Who is going to monitor all of this? What types of tests and audits will we be undergoing? Extremely generic terms like this, from an upper management perspective, rather make my skin crawl.

    I am glad to know that Blumenthal is putting his mighty mind to this, and I hope that the decisions are not made in a silo — now is truly the time to pressure for transparency, especially on such a big decision.

  • The definition of meaningful has to be very clear and concise. Any physician denied Stimulus money will drag in attorneys to debate “meaningful” along the same lines as a recent debate on the definition of the word “is.” If you wait for the all encompassing definition of “maningful” then be prepared for long delays and long debates.

  • Sure, you have to bring the lawyers into all this. I don’t care how clear and concise you define it, I think we can guarantee that there will be some lawsuits once doctors don’t see any money. Seems like a forgone conclusion to me. Unless of course they just open it up so that anyone can get it. I don’t believe that’s likely to happen. They’re going to want to at least act like they’re holding people accountable for the money they’re given.

  • […] John over at EMR, EHR, and HIPAA wrote a great blog on meaningful use, and some of the definitions that are being kicked around in the healthcare IT world.  It is interesting to me that HIMSS includes in its definition of meaningful use ‘decision support.’ […]

  • What I am seeing so far is that “Meaningful Use” is being defined as a set of required features or functions. In my opinion, this is exactly what it should not be (see my previous posts and article).

    “Meaningful Use” should be defined as the ease and intuitiveness with which users are able to complete tasks or achieve goals when interacting with the EMR system. And in even shorter form; the degree to which the user can focus on the task rather than the system.

    The question of how you guarantee “meaningful use” can be answered by incorporating a formal design process. “Meaningful use” should be determined by the degree to which an EMR system supports user workflows and matches user expectations. If it does both of these things well, users will interact with the system in a natural way allowing the system itself to fade into the background as the focus becomes the task rather than the interaction.

    Meaningful use may be measured at several points in the EMR implementation process:

    1. The system has not yet been developed. A formal design process is implemented to determine how existing users approach and complete important tasks, how these processes may be improved and expanded upon, how stakeholder and technology requirements can be accommodated and how the system can be extended to meet the predicted needs of future users. These requirements allow the developer to create a system that exceeds the criteria of meaningful use.

    2. The system has already been developed. Prior to implementation, the research portion of the design process is completed to determine how the existing users currently approach and complete important tasks as briefly described in #1 above. Once these types of issues are known, we can determine the degree to which the current state will need to change to accommodate the EMR. Conversely, we can also determine the degree to which the EMR would need to change. Requests for EMR system modifications can then be provided to the developer to (hopefully) implement before the system is put into service.

    3. The system has already been developed and implemented. Determine which modules are being used, which are being “worked around” and which are being ignored. Whether this system has met basic usability checklist requirements is moot at this point.

    A sharp eye will notice that Option #1 and #2 require the same research into the details of how existing users do what they do. Ideally, we would like to do this research up-front to inform development (Option #1) rather than after development is complete (Option #2). Both both are preferable to Option #3!

  • “I’m not sure where he got this list, but this list feels kind of weak if you ask me.”

    I was thinking the same thing. If that were true, there would have to be some kind of other decisions or laws that better defined it. Like how case law does.

  • @Paul:
    Sure thing, there were really other laws that defined it. Try to check it out again. You can find there were quite a few mentioned.

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