First Look at 'Meaningful Use'

The meaningful use workgroup of the HIT Policy Committee has released its initial recommendations for a definition of "meaningful use" of electronic health records. The definition is important because under the economic stimulus law, providers must "meaningfully use" EHRs to receive financial incentives from Medicare and Medicaid.

These initial recommendations do not include a formal definition of meaningful use. But they are the initial recommendation of the functionalities that will be required by 2011 when incentives start. "This is the beginning of a conversation that will continue for some time," said David Blumenthal, M.D., the national coordinator for health information technology, during a meeting of the HIT Policy Committee, a public-private advisory group. Blumenthal added that "there is a long way to go" before a final definition of meaningful use is achieved.

The workgroup's initial recommendations include 22 objectives--most covering inpatient and outpatient care--for EHRs in 2011. These include, among others:

* Use CPOE for all order types including medications;
* Implement drug-drug, drug-allergy and drug-formulary checks;
* Maintain an up-to-date problem list;
* Generate and transmit permissible prescriptions electronically;
* Maintain an active medication allergy list;
* Send reminders to patients per their preference for preventive and follow-up care;
* Document a progress note for each encounter;
* Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies;
* Provide clinical summaries for patients for each encounter;
* Exchange key clinical information among providers of care;
* Perform medication reconciliation at relevant encounters;
* Submit electronic data to immunization registries where required and accepted;
* Provide electronic submissions of reportable lab results to public health agencies;
* Provide electronic surveillance data to public health agencies according to applicable law and practice; and
* Comply with federal and state privacy/security laws and the fair data sharing practices in HHS' Nationwide Privacy and Security Framework, released in December 2008.

The HIT Policy Committee will make the final recommendations on meaningful use definitions to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

HHS is mandated to publish an interim final rule for standards, implementation specifications and certification criteria of EHRs that qualify for financial incentives by the end of 2009. CMS will develop the formal definition of meaningful use to support the incentive programs. CMS will go through the full administrative rules process with a proposed rule, public comment period and a final rule. A timetable was not given.

The recommendations from the meaningful use workgroup include a matrix of objectives for 2011, plus enhanced objectives for 2013 and 2015. The workgroup will refine the initial recommendations for 2011 and 2013 within three months.

The meaningful use workgroup also has laid out an "achievable vision" for benefits to be realized by 2015. These include reductions in heart attacks, medical errors, and preventable hospitalizations.

For more information, click here. Scroll down and click on "meaningful use preamble" and "meaningful use matrix." Updates from certification/adoption and information exchange workgroups also are available.

--Joseph Goedert

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