We praised the inclusion of HITECH in the American Recovery and Reinvestment Act of 2009 as a stimulus to expand EHR adoption and improve the quality and effectiveness of patient care for all time. Today, many respected healthcare leaders argue that it is time to declare victory and move on.

Those leaders were recently encouraged by CMS leader Andy Slavitt’s announcement that Meaningful Use would end soon and be replaced by something better. Unfortunately, “April Fools” was declared only two days later, when CMS administrators, including Karen DeSalvo, MD, National Coordinator for Health Information Technology, said the program was going to be with us for the foreseeable future. Now, we can look forward to more good ideas from our government.

It is time to consider the impact of Meaningful Use. How has it affected the provider community? How has it accelerated, or retarded, the innovation of healthcare practice? How has it influenced the economics of healthcare? What has it done for the most important stakeholder, the patient? If it has not achieved the full potential ascribed to HITECH, what are the causes and what are the best next steps?

Bill Spooner

My perspective is that Meaningful Use has fallen far short of aspirations.

Progressive hospitals and physicians were already implementing electronic records when HITECH was enacted, and clearly a large majority of others have acquired EHRs since. There are numerous reported gains in quality, patient safety and information sharing among closely aligned providers.

However, hurried implementation schedules did not allow time for effective software and workflow design to support how providers actually practice medicine. Providers have expended great resources to capture measurements that few believe incent better health or healthcare. Even fewer believe that the investment can show a return on investment.

The strong focus on Meaningful Use has diverted resources away from other innovations benefitting patient care and provider productivity. Beyond the incentive payments, few providers would claim that Meaningful Use has improved their work lives.

While as a CIO I was proud for my organization to collect the incentive funds, those payments were but a small percentage of the dollars invested in our EHR, to say nothing of the cost of ongoing support and extension of Meaningful Use.

I naively viewed Meaningful Use as a time-limited program, with specific provider deliverables in exchange for the incentive funding. I failed to recognize the Trojan Horse, with HHS empowered to change requirements over time as its discretion and Congress continuing to weigh in as its many constituencies push for the best advantage.

In one form or another, Meaningful Use is forever!

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The Feds should take a hard look in the mirror and consider the unrealistic expectations and the Meaningful Use structure itself.

Interoperability and information exchange are topics of their own. While some communities report great success, in others information exchange is limited to affiliated providers on common systems. While it has become popular for the Feds to decry “information blocking”, the principal blockers are imprecise standards (including patient identification), immature governance models, inadequate funding and a lot of unnecessary work. The Feds should take a hard look in the mirror and consider the unrealistic expectations and the Meaningful Use structure itself. They paid out most of the several billion dollars absent solid standards and without more than a token requirement for information exchange.

The impact of Meaningful Use on the patient is much harder to discern. HITECH motivated EHR adoption itself, so the capabilities of the electronic record in many ways have enabled better care.

As a patient, for example, I may never know if an automated drug alert saved my life. I certainly appreciate the convenience even of the limited online access through my provider’s portal. It would be difficult, however, to document the clinical benefits of many of the Meaningful Use measures. For example, how many patients stopped smoking because they were asked about their smoking status?

I recommend that we freeze Meaningful Use and focus on specific advances--solid standards including patient identification, rationalization and harmonization of quality indicators--and gradually increase thresholds for key current measures such as portal utilization, but add no new requirements. Leave innovation, usability and product comparisons to the marketplace.

As a nation we are known for our ability to invent. Let us accept the challenge and invent!

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