Industry Raises its Voice on 'Meaningful' EHR Use
Health Data Management Magazine, July 1, 2009
The Department of Health and Human Services by year-end must define "meaningful use" of electronic health records. The definition will be a key benchmark for providers to meet to qualify for the Medicare and Medicaid financial incentives under the economic stimulus law. In recent weeks, numerous industry organizations have made their views on the topic known to federal officials. A federally created definition of meaningful use of electronic medical records must focus on outcomes and not mandate specific functionalities, according to the College of Healthcare Management Executives in Ann Arbor, Mich. "The bottom line for these efforts is better health/better outcomes," the CIO association recommended in comments to the National Committee on Vital and Health Statistics, a federal advisory body. "Using an EMR and other I.T. tools to accomplish this goal is clearly about outcomes and less about the technology." CHIME also recommended using a phased approach to meaningful use of EHRs to encourage early adoption without raising the bar too high too early, and exploring alternative means of connectivity in the short term and connection to a health information exchange over time. Beyond Functionality The American Medical Informatics Association in Bethesda, Md., believes meaningful use should go beyond the criteria necessary for certifying such systems as meeting specific functionality standards. "Any EHR used should be certified through a suitable process, but 'meaningful use' implies attention to how an EHR is implemented and used for patient care and health promotion," the association noted in comments to the NCVHS advisory body. "For example, decision support capabilities should not simply be 'present' in an implemented EHR, but should be tested against an external standard, such as the Leapfrog test, which verifies that specific elements of decision support are in place and in use." A report endorsed by representatives of more than 60 organizations calls for the definition of meaningful use to focus on improving medication management and the coordination of care. The organizations, operating through the Markle Foundation, a New York-based think tank, offer a simple proposed meaningful use definition: "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 report notes: "The meaningful use definition must optimize achievability for providers and benefits to patients and consumers. Improving medication management and coordination of care provides early opportunities for such optimization. Meaningful use should initially rely on standard information types, such as recent medications and laboratory results, that are electronic and already widely adopted and that can support metrics to improve medication management and coordination of care." Testifying before the NCVHS advisory body, software and medical imaging vendor GE Healthcare counseled regulators to initially set the bar for meaningful use relatively low. "For 2011 and 2012, we urge that meaningful use start at readily achievable levels," according to a statement from the vendor. "We envision a steady growth over time in the breadth and depth of meaningful use requirements. Increases should stair-step upward, with each level in use for 24 months." Incremental Steps Also taking an incremental approach, the Healthcare Information Management and Systems Society released two definitions for meaningful use. For both hospitals and physicians, the organization recommends three phases of definitions, for a minimum of two years each, starting in fiscal year 2011. For example, HIMSS recommends that hospital use of computerized physician order entry system not be an initial requirement in the first phase of definitions. But the second phase should require at least 51% of medical orders be electronically entered by physicians via CPOE, rising to 85% in the third phase. For physicians, HIMSS recommends in the first phase an EHR infrastructure that includes clinical data display and CPOE with "independent licensed practitioners" entering the order. In the second phase, the physician's CPOE must be supported by clinical decision support, according to HIMSS. The third phase would require exchange of patient summary information via the Continuity of Care Document standard. "This means that not only must the information be transmitted via the CCD; it also means that receiving entities must be able to use the CCD as a source of information to input and/or update information in their version of the record." (c) 2009 Health Data Management and SourceMedia, Inc. All Rights Reserved. http://www.healthdatamanagment.com/ http://www.sourcemedia.com/
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