Meaningful Use Feedback for ONC and CMS – Meaningful Use Monday

Today I thought I’d cover some feedback and comments that have recently been posted on some of my previous posts. Some are feedback for ONC on meaningful use. Another suggests that more of us get involved in the meaningful use rule making process. These comments and others that I’ve ready have me wondering if I and others of my readers should be playing a more active role in helping form the meaningful use criteria.

As is evidenced by the 60 Minutes interview with Jack Abramoff last night, there’s so much messed up about Washington and the legislative process. I guess I partially see that with meaningful use and the HITECH Act and I’m sure there’s plenty more happening in Washington DC that I don’t know about.

The problem I see is that the ones interested in being actively engaged in the rule making process are those that have the most financial benefit to gain. Certainly all of us have some reason to care how our government spends money and particularly the health of our healthcare system. Unfortunately, financial benefit seems to be a much stronger motivating force to participate than the greater good.

Look at it this way. If I’m an EHR vendor that’s going to have to comply with meaningful use and use it and EMR certification to sale my product, then I have a reason to pay for someone to fly to Washington DC and be involved in the process. I could even make some reasonable argument for me as an EHR and healthcare IT blogger to make the journey to Capitol Hill to talk about what’s happening. In fact, I’m going to be in DC in December, but I’m not going there to help improve meaningful use. The idea of getting ONC and CMS or other members in Washington DC to talk with me about meaningful use and the HITECH act sounds daunting and I’m not sure it’s worth the effort for a one time event.

Does that basically mean that ONC and CMS are listening mostly to those who have a vested financial interest in meaningful use and certified EHRs?

I like many others would likely be happy to share our voice in the meaningful use stage 2 creation process. It just feels so hard to participate and with little confidence that our voice will be heard above those who are paying a lot more to have their voice played over a proverbial loud speaker. I’m sure most doctors feel this same way. Although, Dr. Koriwchak over at Wired EMR Practice was in Washington DC this last week. I’ll be interested to hear more details on his visit, but I think his visit came as part of a larger health organization. Evan Steele of SRSsoft has a good post requesting other medical organizations become more involved in the meaningful use process. Could they be an independent voice for the physicians they represent?

Enough ranting about the challenge of working with the government to shape policy. Although, a comment from Anthony Subbiah was what prompted my reaction above. The following are Anthony’s comments from my Small EHR Vendor and Specialty EHR post suggesting that EHR vendors get more involved in the process:

As a vendor who works with ONC, and having gotten to know them better, they do have the greater good in mind; and some of these hurdles are un-intended and un-foreseen. The Phase II of the meaningful use requirements are in pilot and this is a good time for the EHR vendors to work with ONC and point out the flaws which ONC will graciously accept and review. It has been interesting working with ONC and understanding their thought process goes a long way in positioning and requesting exemptions. Key here is for the EHR vendors to spend the time and effort and work with ONC helping to meet their objectives.
On another note, while reducing the expenses is the goal, its more about the reduction of wastefull expenses which is being targeted to get the healthcare costs under control.

ONC maintains an extensive directory and blog of what they do at WIKI and any company interested can join. In order to realize value, the companies interested should be able to dedicate one or two senior resources towards this; there are many pilots that go on related to MU Phase II; the EMR companies can participate in the Pilots, provide their inputs and the ONC group is more than willing to listen. Actually, this is a great group of people to work with and they take the input and integrate that within the initiatives framework. We do not participate in all the Pilots – we are participating in two of them currently.
I believe its better to participate and shape the outcome as opposed to sitting on the sidelines and later on finding fault in such initiatives…………..

Here’s a link to the Wiki that Anthony mentions.

The other comment that prompted this post was a comment made by Julie Lundberg about the meaningful use smoking status requirement:

In an attempt to improve ‘Usability” we are trying to build a smoking status that will satisfy both the Core Measure (which requires CDC smoking status categories) and CQMs (which require SnoMed codes). There is no 1-1 relationship between the 2 lists. In fact, the CDC list makes no distinction between a “Light” cigarette smoker (1-9 cigs/day) and a “Very Heavy” cigarette smoker (40+ cigs/day). Both would be considered a “Current every day smoker”. We can obviously gain this granularity with SnoMed codes but this makes the task more onerous for the provider to capture (selecting from 2 lists of “descriptions”). Let’s give the Providers 1 smoking status to fit all requirements.

It’s an interesting question for which I don’t have the answer to which feels odd since I feel that I’m reasonably well versed with meaningful use and the creation of the meaningful use creation process. The only way to know the answer to this is to have been intimately involved in the creation process in Washington. Something no doctor that sees patients daily can really do.

I love that Julie was willing to offer her suggestion on my EMR blog. Plus, I know that a number of people from ONC read this site, so I’m hopeful that now that I’ve posted Julie’s comment it will get more traction from the people in Washington. However, I still feel there needs to be an easier way for those who can’t spend their days following the latest meaningful use happenings in Washington DC to have their voice heard in the process. Then, they wouldn’t have to resort to blogs like mine to provide comments.

I’m open to other suggestions on how regular people can get involved in the process. Maybe my personal fear of involvement is that I want to actually effect change on something I’m involved in. It seems like casual involvement in the process isn’t enough to be heard. I guess that’s the problem when you want what you said to be meaningful (ie. actually heard and used).

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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,, 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.


  • MU Stage 2 = Smoking Status Redux
    John, you must be right about ONC folks reading your blog! Here we are nearly 2 years later preparing for MU Stage 2 and smoking status requires renewed attention. The ONC has published a new list of Smoking Status categories, which now also includes mapping to Snomed Codes (yay!). On the one hand, I applaud the effort to bring the 2 classification systems in line (I can select a smoking status category that meets the core set objective while also triggering my CQM count because it has a Snomed code). On the other, we are presented with the problem of mapping MU Stage 1 categories (and our original Snomed code associations) with the new MU Stage 2 categories (that come pre-associated with Snomed codes). I am also pleased that they added Heavy and Light distinctions, but am disappointed that they didn’t include Moderate or Very Heavy. So now it’s our job to help our users make sense of the new categories. Do we make them pick smoking status all over again, using the new Stage 2 list? Do we map Stage 1 options to the new Stage 2 list? In Stage 3, will the ONC add Moderate and Very Heavy, forcing us to go through this exercise again?

  • Thanks for sharing Julie. I know some do read it. I’ve seen their email subscriptions.

    You bring up some really interesting points. I’m going to do a future post highlighting the challenges you mention.

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