Health IT Provisions Under ARRA:
Section 2: What Is Meaningful Use?
Proposed Simple Definition of Meaningful Use:
- Patient-Centered, Meaningful Use of Health IT:
- Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs.
- Initial Meaningful Use Requirements (2011-2012):
- Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care.
The Path Toward Early Progress Should Begin with Information that Has the Greatest Potential to Achieve the ARRA Goals
Given current economic urgency and ARRA's statutory deadlines, the HHS Secretary should focus initially on encouraging the use of information that:
- Has the highest potential impact on health improvement and control the growth of costs.
- Can be achieved with current technologies and made available at the point of care in standardized electronic formats in the near-term.
- Includes flexible requirements that enable a broad range of providers and patients to benefit.
Based on these criteria, we recommend an initial focus on the use of standard information types or packages for recent medication histories, recent test results (particularly laboratory values, and when available, imaging and pathology text reports), and care summaries. These three classes of information hold significant potential compared with many other types of health information for improvements in coordination of care, medication management, and reduction in duplicative services.
In terms of achievability, medication history and laboratory results are among the most electronically available, as well as among the most codified or formatted for readability by both humans and machines. Standards exist for sharing this information and are in use in many places. For example, ARRA sets a clear expectation that electronic prescribing will be a form of meaningful use. In order to achieve health improvement goals, electronic prescribing systems can be used to improve medication management (e.g., enable drug-interactions checking, support evidence-based protocols, present therapeutic alternatives/most cost-effective alternatives, reduce errors due to illegible handwriting). There has been significant progress in use of standards for patient information summaries for exchange during transitions in care. (See Appendix A.) The ARRA incentives should drive higher demand at the point of care by establishing quality-improvement goals that rely on these already-digital data types.
Similarly, early and widespread availability of these standardized, computable data formats can accelerate use of more robust clinical quality objectives. We envision a phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.
Although we have proposed a much-simplified definition of meaningful use, we fully realize the complexities of the U.S. health sector and the Medicare and Medicaid programs. It is likely that HHS will need to create different definitions and metrics to accommodate this complexity, such as different incentive structures for Medicare and Medicaid. Another consideration will be the base of clinicians who have already installed EHRs (even those certified by the Certification Commission for Healthcare Information Technology (CCHIT)) that are not yet capable of the basic information exchanges of these three priority data types.
The HHS Office of the National Coordinator for Health Information Technology (ONC) should direct a significant part of $2 billion in ARRA's non-entitlement health IT funding toward laying the groundwork to help health care practices connect securely and effectively to networks, such as privacy-enhancing identity management protocols and directories that allow an authorized clinician to find the location of the right patient's records on a network. For example, HHS could support the development of interface standards that would facilitate the exchange of information to and from these systems so that the physicians who already have made considerable investments are not unintentionally penalized, and are able to participate in incentives to improve quality and care coordination.
Despite a need to accommodate exceptions such as these, HHS can send a strong signal to the marketplace by keeping its initial focus on improvements in care coordination and medication management, creating demand for better information and care processes to benefit large numbers of clinicians and consumers.
