Is Meaningful Use a Floor or Ceiling?

I was witness to an interesting discussion earlier this week at the Wisconsin Technology Network’s Digital Healthcare Conference in Madison, Wis.: Is meaningful use a floor or a ceiling?

One panelist, Judy Murphy, VP of information services at Aurora Health Care in Milwaukee, said Stage 1 meaningful use has caused the health system to alter its own IT plans by activating a patient portal and moving more toward interoperability sooner than intended. “We wouldn’t have decided to give electronic copies of clinical summaries at discharge [without meaningful use],” Murphy said.

But Murphy believes it’s a floor for many of the criteria, such as the requirement that 30 percent of patients have at least one medication order entered electronically. “No one would go into an implementation shooting so low,” she said. As a member of the Health IT Policy Committee as well as the Meaningful Use Workgroup of the Health IT Policy Committee, Murphy actually had a hand in shaping the standards. (Remember, though, the original proposal called for 10 percent for hospitals and 80 percent for physicians. The final Stage 1 rule set the threshold at 30 percent for both.)

Gartner analyst Vi Shaffer offered a counterpoint. “Meaningful use is not the floor,” she said. “All the existing quality measures that have been out there so long should be considered the floor.” Shaffer expressed frustration that so many 12-year-old National Quality Forum performance measures still haven’t been met.

According to Shaffer, the idea behind meaningful use is to “lift people up,” particularly when it comes to safety-net providers like critical-access hospitals. Shaffer said policymakers didn’t want to see “oligopolies” in local markets because smaller providers were forced to merge with large health systems because of EHR requirements.

Session moderator Dr. Barry Chaiken, chief medical officer at Docs Network Imprivata, and a former HIMSS chair, said he believes health IT will raise the norm for all providers and “lock in” better behaviors, suggesting that in some ways, meaningful use could be a floor.

By holding the conference in Madison, WTN was able to land the publicity-shy Judy Faulkner, CEO of Epic Systems in nearby Verona, Wis. Faulker noted that Epic shows a simpler version of its core EHR in overseas markets because the company had to add some functions for regulation and liability purposes in the U.S.

While plenty of providers are viewing meaningful use as a ceiling right now–perhaps an unattainable one–Murphy believes acceptance will come rapidly. “I think in 2015, we’re gonna look and say, ‘How did we even have healthcare without computers?'” Murphy said. She then said she had heard that HCA would attest this year to meaningful use at all of its U.S. hospitals.

Being the occasionally motivated reporter that I am, I tweeted this statement, asking for verification. Wouldn’t you know, HCA replied with this tweet: “Nearly all HCA facilities should achieve requirements 4 Stage I this yr. An exciting, important step for high-performance hcare!”

So maybe meaningful use is not a floor or ceiling, but the new norm.

What are your thoughts?

CORRECTION, June 13: Chaiken’s one-year contract with Imprivata is over, so he’s no longer affiliated with that company.


About the author

Neil Versel

Neil Versel


  • John, I was stunned to see the statement by Shaffer that “policymakers didn’t want to see “oligopolies” in local markets because smaller providers were forced to merge with large health systems because of EHR requirements.” I feel like I am reading everywhere that physicians are selling their practices because they can no longer afford to stay independant. You know how much effort it takes to implement and manage an EMR system, plus it requires a more highly educated staff to do it. This is contributing to increased costs in the clinics. That combined with shrinking reimbursements and increased patient obligations is putting enormous financial pressure on the smaller clinics. I can totally envision a healthcare system that completely loses the small family practice or specialty office. How could that result not be imagined by the policy makers?

  • John … What has happened in other industries when technology in this case IT was added to the production process? Answer: Customer demand for higher processing speeds to support more capable software to meet existing or emerging business needs. Competition in the industry market drove faster more capable tools.

    Artificial standards will always overshoot or undershoot where adoption of technology should be as relates to the business (and in this case clinical support) processes.

    If you are a provider … and all you want to be is compliant … then that is what you want to buy … nothing more and nothing less … until the provider has reason to buy more to do more.

    If all those non-supported quality measures really are important from business and clinical practice level viewpoints … and not just important because the government says they are … then applications ought to be offered beyond the base MR standard and offer more robust levels of capability and capacity. (e.g. MS Office Home Edition, MS Office Home and Student, MS Office Home and Business, Office Professional).

    HOWEVER … as soon as the governement sticks its nose into the marketplace and establishes a bar … it becomes the ceiling for those who have to buy applications and the floor by those who build applications.

    Who wants to spend corporate programming dollars to build something some academic geeks think ought to be sold because they think it’s the right thing … but nobody else who is really in the market agrees? You got to bury those engineering costs somewhere … and that just makes the basic package more expensive … or the advanced package that is under subscribed to more expensive.

    Just sayin …

  • Mary and Don,
    Thanks for your comments. Although, Neil Versel actually wrote this article. You can see who wrote it at the top of the article. Maybe I should add a byline for Neil’s post as well. I’ll have to think about that. He’ll be posting on Thursday’s.

    I’m not sure EMR is the reason that so many small practices are selling to hospitals. It might be a small contributing factor, but I’d say other factors are much bigger issues.

    I still believe it will be the same cycle we’ve seen before where small practices get bought out by hospitals, then they leave to start their own practice again.

  • After I posted I noticed that Neil authored the OP … I think his perspectives are quite valuable and gave you a baseline on which to compare and contrast.

    Progression to higher features in software packages are in response to demands of the customer base who raise the bar on their needs based on business and clinical demands of their practices.

    Initially practitioners view what they require as their ceiling while developers view it as their floor. The market demands are the most effective means for raising the bar versus government requirements which may provide no value to the practice and are an unnecessary development cost to the developers.

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