HIT Think

Sorry, Experts. Meaningful Use is a Success

A federally funded study finds that criteria under the electronic health records meaningful use program “fall short of achieving meaningful use in any practical sense.” Don’t believe it.

The report contends that interoperability in the meaningful use program is basically meaningless, amounting to “little more than replacing fax machines with the electronic delivery of page-formatted medical records.” And that has some merit, but interoperability isn’t the end-all toward meaningfulness. The report then offers a comprehensive software architecture for Stage 3 of the meaningful use program that would create a truly interoperable health data infrastructure. That’s wonderful if report authors don’t care about what is really feasible for the health care industry during Stage 2 now, and Stage 3 in just three years.

The report was written by the JASON initiative within MITRE Corp., which operates federally funded research and development centers. JASON, named after the mythological Greek explorer, is an independent group of scientists that advise the government on matters of science and technology.

Where did the JASON experts get their information on the meaningful use program? From 18 other experts in the health arena, mostly university researchers, consultants and vendors. After Googling these 18 experts, it can charitably be surmised that maybe seven of them have ever used an EHR. This report is an academic exercise that need not consider the real world.

The key takeaway here is that the feds, specifically the Agency for Healthcare Research and Quality which funded the report, really need to spend taxpayer dollars more wisely. It simply is folly to say that a decent degree of EHR meaningful use has not been achieved in just four years. Think back to early 2009 when the HITECH Act that ushered in the meaningful use program was signed.

The first goal of meaningful use was to vastly accelerate EHR adoption. By any measure, that has been a success. As of this past February, 453,426 eligible professionals had registered for the Medicare or Medicaid meaningful use programs, as had 4,711 hospitals. That means at minimum that these providers have EHRs or are darn close to getting them. As of February, 355,557 unique providers had received financial incentive payments under the program.

Any physician, nurse, or other health professional using an EHR simply has more available information on a patient than those documenting on paper. That’s damn meaningful. If the clinicians have gone through Stage 1, they are collecting demographic information for analysis, recording vital signs on a regular basis for tracking, maintaining problem/medication/allergy lists, giving patients more information through clinical summaries, using CPOE and e-prescribing, conducting drug safety checks, using some degree of clinical decision support, reporting clinical quality measures to regulators, and have at least tested electronic data exchange to some degree. Now, how many clinicians were doing any of these tasks electronically before the meaningful use program came along?

The meaningful use program has really been in operation for only about three years. Report authors are correct that interoperability is still lacking, yet it has advanced considerably more in three years than in the previous 20.

Stage 2 is off to a slow start because providers already had many other critical initiatives on their plates, and the second stage raises the bar significantly, including for interoperability. Many providers and vendors need more time to step up their game. That’s not failure. That’s what’s meaningful.

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