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The health care industry in mid-June got its first look at what a definition of "meaningful use" of electronic health records might look like, and the picture was decidedly murky.

"We would have liked to have seen more specificity around terms being used," says Mark Segal, director of government and industry affairs for the information technologies unit of GE Healthcare, Waukesha, Wis. "What exactly does 'access' mean?" Another example: one proposed objective for meaningful use of EHRs called for maintaining an up-to-date problem list. But what does "up-to-date" mean? Segal asks. "The sooner we get a high degree of specification, the better."

A definition of meaningful use of EHRs is important because it is a major requirement for receiving Medicare and Medicaid incentives, starting in 2011 and funded under the federal economic stimulus package.

The HIT Policy Committee's workgroup on meaningful use released a matrix on June 16 listing proposed objectives to be met to demonstrate meaningful use of EHRs, along with measures of the degree to which the objectives had to be met. The first objective listed for 2011 - to use CPOE for all order types including medications - was a doozy that observers expect to be considerably softened. "Getting CPOE for all orders in 2011 is wildly ambitious," says Erik Johnson, managing director at Manatt Health Solutions, a Washington-based consulting firm. "I just don't see how hospitals get there in 2011."

The Starting Line

The industry can expect this summer to see more drafts of the direction a meaningful use definition is moving toward, as federal officials work to get a formal proposed definition published by year-end. But for Harry Greenspun, M.D., chief medical officer at Perot Systems Corp. in Plano, Texas, a major question is where the starting line will be. An organization shooting for getting the incentives in 2011 obviously will have to meet initial meaningful use requirements that go in effect at that time. But there likely will be more stringent requirements in 2013 and 2015. So, Greenspun wonders, will an organization starting in 2013 have to meet initial 2011 criteria or more advanced 2013 requirements? "Does everyone get to the same end point at different times or do they get there at the same time?"

Consultant Johnson was surprised at the emphasis on patient and family enfranchisement in the initial draft. An objective for 2011 called for providing patients with electronic access to such clinical data as lab results, problem list, medication list and allergies through personal health records or other means. The level of emphasis was surprising, he says, because the consumer side was not emphasized at public hearings. Such empowerment is not, Johnson says, on the radar for most providers.

Vendor Readiness

Will EHR software vendors be able to have their products comply with meaningful use requirements in time for providers to qualify for the first incentive payment in 2011? That's a fair question if one recalls the dismal performance of many vendors in meeting HIPAA transactions rule requirements on time.

"From a technology standpoint, I'd say the industry is pretty ready," says GE's Segal. "The sooner we can get clarity on the definition of meaningful use, how it's going to work out, and what we and our customers need to do, the longer we can work with customers to help them achieve meaningful use."

Perot's Greenspun thinks vendors will be ready in time. "Doing it means they can sell the latest version of their software." The question, he notes, is whether vendors will retrofit existing technology or force customers onto new platforms.

What Greenspun worries about is provider readiness. "Hospitals have I.T. staff, but physicians don't have the resources or expertise. They're going to face the prospect of having to adopt technology fairly rapidly."

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