"Meaningful Use" Almost Defined

HIT Policy Committee released the following draft definition (if you missed the meeting the transcript is here, along with presentation materials) of meaningful use today:

“Meaningful Use: A Definition”

Recommendations to the Health IT Policy Committee from the Meaningful Use Workgroup

The American Recovery and Reinvestment Act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR). These incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare.

FRAMEWORK FOR DEFINITION

In 2008, the National Priorities Partnership, convened by the National Quality Forum (NQF), released a report entitled “National Priorities and Goals” which identified a set of national priorities to help focus performance improvement efforts. Among these priorities were patient engagement, reduction of racial disparities, improved safety, increased efficiency, coordination of care, and improved population health. These priorities were used to create the framework for “meaningful use” of an electronic health record. An additional area related to privacy and security has also been included to emphasize the importance of preserving patient protections and ensuring patient trust in the use of electronic health records. The matrix represents a set of objectives and care processes that the workgroup believes should inform the ultimate definition of meaningful use.

PROGRESSION TOWARDS ULTIMATE GOAL

We recommend that the ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system. The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real‐time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities. This "north star" must guide our key policy objectives, the advanced care processes needed to achieve them, and lastly, the specific use of information technology that will enable the desired outcomes, and our ability to monitor them. For example, demonstrating improved performance and reduced disparities in blood pressure control among patients with diabetes will require a host of new care processes for many outpatient providers (e.g., monitoring medication adherence, use of evidence‐based order sets, clinical decision support tools at the point of care, patient outreach and reminders).
In order to effectively use the tools that undergird these processes, and to monitor progress towards the outcomes of interest, key information generated in the delivery of care (vital signs, problem lists, medications, procedures, lab tests) must be digitized and queriable. We recognize that changing products and changing workflows will be an evolving process, but providing a clear roadmap of the future (as we have attempted to do in this proposed definition of meaningful use) will help give purpose and meaning to these activities. We recommend a progression similar to the Electronic Health Record demonstration initiated by the Centers for Medicare and Medicaid (CMS) in 2008, wherein “meaningful use” is ultimately linked to achieving measurable outcomes in patient engagement, care coordination, and population health.
In developing the recommended criteria and prioritizing the progression towards a fully interoperable health information system, we have found it necessary to balance the competing goals of encouraging provider participation while promoting progress towards reform of our current health care system. We seek specific stakeholder feedback on whether the recommended timeline of requirements is overly aggressive based on the current state of technology and the demands on new provider workflows, or not challenging enough to result in significant transformation, in light of the declining level of Medicare incentives in future years.

TRANSFORMED HEALTHCARE

As a result of increased effective use of health information technology, considerable improvements will be realized in the prevention and management of chronic diseases including diabetes and heart disease, preventing hundreds of thousands of unnecessary amputations and premature deaths. Medication errors will be averted. Patients will be able to promptly access their own health information, and their end of life preferences will be heard. The nation will be better prepared for the next pandemic. Health care disparities will be systematically identified and addressed. This transformed healthcare delivery system will also enable and amplify the effectiveness of a host of new reimbursement models that will reward more organized, more coordinated, and more efficient care.

PROVIDER TYPE

The recommended definition of “meaningful use” will depend on the healthcare setting in which it is employed. Thus, some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital. This reflects both the availability of the technology in these different settings as well as the potential impact of these features on the health of the population served. Although some recommended measures used to assess meaningful use in 2011 may apply to specific chronic diseases, the recommended 2011 objectives are meant to establish a foundation for affecting a more comprehensive set of health outcomes in the future. Many of the current proposed EHR­generated quality measures apply to primary care providers and are derived from NQF‐endorsed measures. New measures under development, by NQF, and other recognized organizations will also address the work of specialists. The Workgroup anticipates that future recommended meaningful use objectives and measures will reflect emerging national priorities.

MEASURES

In identifying potential criteria for “meaningful use” of an electronic health record, it became apparent that there are considerable gaps in EHR‐generated measures available to monitor key desired policy outcomes, (e.g., efficiency, patient safety, care coordination). While these measures will not be required for Medicare and Medicaid incentive payments until 2013 , the Workgroup is seeking feedback on how to best frame these measures including measurement of key public health conditions, measuring health care efficiency, and measuring the avoidance of certain adverse events. These comments will be used to help revise the recommended measurement strategy to include more extensive and refined outcome measures for “meaningful use” in 2013 and beyond.

The Convergence of #HealthIT and #Web2.0

At the intersection between Web 2.0, social media, Health IT and healthcare reform lies the tools of the new economy. Aside from the blogosphere, a whole host of social media tools can be useful to provide real time information, networking possibilities and develop grassroots efforts for reform. As Cascadia has said we now have a consumer voice in the ongoing Health Informatics conversation using the new social networking tools.

Tim O'Reilly, Founder and CEO of O'Reilly Media, was interviewed by Blaise Zerega of Flora.tv at Web 2.0 2009. In the clip below he argues that microblogging service Twitter is changing real-time information search and describes how Twitter is going to be such a powerful tool in the new digital economy.



Forrester Research CEO George Colony calls the current economic trouble the Gateway Recession, and end of the Gateway Recession will usher in a new technology era. In discussing the importance of social media in this new economy Rob Preston, Editor-in-Chief of Information Week makes a compelling argument that one "gateway realization is the need to give customers, partners, and employees freer access to one another via social media, Web 2.0 collaboration tools, consumer devices, and other contraband systems."

The discussion of hugging data and the video of Tim Berners-Lee's Ted Talks where he envisioned a "Semantic Web" - an evolved version of the same system that recognizes the meaning of the information it carries. As I said, we need to consider how we can best securely share data and develop open standards that work. Social media provides a wonderful framework for collaboration.

The conversation continues and you can jump in any time...

Alphabet Soup

There are many commonly used abbreviations in discussing Health IT. I thought it might be helpful to list some here:

AHIC American Health Information Community

AHIMA American Health Information Management Association

AHRQ Agency for Healthcare Research and Quality

ANSI American National Standards Institute

CCHIT Certification Commission for Healthcare Information Technology

CDS Clinical Decision Support

CHC Community Health Centers

CMS Centers for Medicare and Medicaid Services

CONNECT NHIN gateway

CPOE Computerized Physician Order Entry

EHR Electronic Health Record

EMR Electronic Medical Record

FHA Federal Health Architecture

HHS Department of Health & Human Services

HIE Health Information Exchange

HIMSS Healthcare Information Management Systems Society

HIPAA Health Insurance Portability and Accountability Act

HIT Health Information Technology

HITSP Health Information Technology Standards Panel

HL7 Health Level 7

HRSA Health Resources and Services Administration

ICD International Statistical Classification of Diseases and Related Health Problems

JCAHO Joint Commission on Accreditation of Healthcare Organizations

NCVHS National Committee on Vital and Health Statistics

NHIN Nationwide Health Information Network

NIH National Institutes of Health

NLM National Library of Medicine

ONC Office of the National Coordinator (usual abbreviation for ONCHIT)

ONCHIT Office of the National Coordinator for Health Information Technology

PHR Personal Health Record

PQRI Physican Quality Reporting Initiative

RHIO Regional Health Information Network

SLHIE State Level Health Information Exchange Consensus Project

SNOMED Systematized Nomenclature of Medicine

VHA Veterans Health Administration

VistA Veterans Health Information Systems and Technology Architecture

I particularly would like to point out the differences between EMR, EHR and PHR. These terms tend to be used interchangeably, but they actually refer to different things. In fact the definition of EHR depends a lot on what the definiton of "meaningful use" is. You could define an EMR as just the physician interface and EHR including both a physician and patient interface (with some interoperability between systems). PHR is still an ill-defined concept that has been slowly developing over many years. Certainly PHR is a computerized application that stores an individual's personal health information. The key difference being that a PHR is typically a health record that is created, controlled and maintained by an individual patient, while the EMR is created, controlled and maintained by the provider. Hopefully one day we will have an intersection at truly meaningful EHR.

Affordable Health Choices Act

The Senate Committee on Health, Education, Labor and Pensions (HELP) has announced the Affordable Health Choices Act.

“Our health care system is a crisis for American families and President Obama and members of Congress of both parties recognize the urgency of the problem. Our goal is to strengthen what works and fix what doesn’t. Over the next few days, we will continue working with our Republican colleagues on common sense solutions that reduce skyrocketing health care costs, assure quality care for all and provide affordable health insurance choices. Much work remains, and the coming days and weeks won’t be easy. But we have a unique opportunity to give the American people, at long last, the health care they need and deserve,” said Senator Kennedy, Chariman of HELP.

Earlier this year, Kennedy and Senator Max Baucus, Chairman of the Finance Committee, which shares jurisdiction of health care reform with HELP, established a joint process that will lead to complementary legislation being marked-up next week. The full text of the bill is available here.

The bill is silent on the crucial questions of the employer mandate and a public health insurance option. The HELP bill proposes broader reform measure than expected in the Finance Committee's bill, expected to be released over the next few weeks. This summer is going to be an exciting time for healthcare reform!